Non-response to rituximab therapy in rheumatoid arthritis is associated with incomplete disruption of the B cell receptor repertoire. Issue 10 (19th June 2019)

• Record Type: Journal Article
• Authors: Pollastro, Sabrina; Klarenbeek, Paul L; Doorenspleet, Marieke E; van Schaik, Barbera D C; Esveldt, Rebecca E E; Thurlings, Rogier M; Boumans, Maria J H; Gerlag, Danielle M; Tak, Paul P; Vos, Koen; Baas, Frank; van Kampen, Antoine H C; de Vries, Niek
• Is Part Of: Annals of the rheumatic diseases. Volume 78:Issue 10(2019)
• Page Start: 1339
• Page End: 1345
• Publication Date: 2019-06-19
• Subjects: rheumatoid arthritis -- rituximab -- b cells -- b-cell receptor repertoire -- next-generation sequencing; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-214898
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objective: To gain more insight into the dynamics of lymphocyte depletion and develop new predictors of clinical response to rituximab in rheumatoid arthritis (RA). Methods: RNA-based next-generation sequencing was used to analyse the B cell receptor (BCR) repertoire in peripheral blood and synovial tissue samples collected from 24 seropositive patients with RA treated with rituximab. Clonal expansion, mutation load and clonal overlap were assessed in samples collected before, at week 4 and at week 16 or 24 after treatment and correlated to the patients' clinical response. Results: After 4 weeks of rituximab-induced B cell depletion, the peripheral blood BCR repertoire of treated patients consisted of fewer, more dominant and more mutated BCR clones. No significant changes in the synovial tissue BCR repertoire were detected until week 16 post-treatment, when a reduced clonal overlap with baseline and an increased mutation load were observed. In patients who were non-responders at month 3 (n=5) using the European League Against Rheumatism response criteria, peripheral blood samples taken at week 4 after rituximab treatment showed more dominant clones compared with moderate responders (n=9) (median (IQR): 36 (27–52) vs 18 (16–26); p<0.01) and more clonal overlap with the baseline (median (IQR): 5% (2%–20%) vs 0% (0%–0%); p≤0.01). Conclusion: Significant changes in BCR clonality are observed in peripheral blood of patients 4 weeks after rituximab treatment, while changes in synovial tissue were observed at later time points. Incomplete depletion of the dominant baseline peripheral blood BCR repertoire in the first month of treatment might predict clinical non-response at 3 months.