ReviewArthritis research & therapy2013
B-cell depletion in SLE: clinical and trial experience with rituximab and ocrelizumab and implications for study design.
Review in Arthritis research & therapy, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
51 citing papers in PubMed, 3 syntheses or guidelines pooled it, 136 citations in OpenAlex.
- Efficacy and safety of rituximab for systemic lupus erythematosus treatment: a meta-analysis.African health sciences · 2020Pooled it
- Corticosteroids combined with doublet or single-agent immunosuppressive therapy for active proliferative lupus nephritis.Clinical rheumatology · 2019Pooled it
- Biologics in the Treatment of Lupus Erythematosus: A Critical Literature Review.BioMed research international · 2019Pooled it
- InterferonFrontiers in immunology · 2020Trial
- Efficacy and safety of rituximab in Japanese patients with systemic lupus erythematosus and lupus nephritis who are refractory to conventional therapy.Modern rheumatology · 2016Trial
- Efficacy and safety of rituximab in Japanese patients with relapsed chronic immune thrombocytopenia refractory to conventional therapy.International journal of hematology · 2015Trial
- Autoantibodies as Precision Tools in Connective Tissue Diseases: From Epiphenomenon to Endophenotype.Antibodies (Basel, Switzerland) · 2026Review
- Anti-CD20 therapy in lupus nephritis: A revisit.Rheumatology and immunology research · 2025Article
- Opportunities and limitations of B cell depletion approaches in SLE.Nature reviews. Rheumatology · 2025Review
- The importance of developing reproducible primary endpoints for clinical trials in systemic lupus erythematosus.Clinical rheumatology · 2025Review
- Immunotargets and Therapy for Systemic Lupus Erythematosus.ImmunoTargets and therapy · 2025Review
- The essential roles of memory B cells in the pathogenesis of systemic lupus erythematosus.Nature reviews. Rheumatology · 2024Review
- KLF13 promotes SLE pathogenesis by modifying chromatin accessibility of key proinflammatory cytokine genes.Communications biology · 2024Article
- Disrupting B and T-cell collaboration in autoimmune disease: T-cell engagers versus CAR T-cell therapy?Clinical and experimental immunology · 2024Review
- A new perspective on therapies involving B-cell depletion in autoimmune diseases.Molecular biology reports · 2024Article
- CAR T-cell therapy for systemic lupus erythematosus: current status and future perspectives.Frontiers in immunology · 2024Review
- Progress of rituximab in the treatment of systemic lupus erythematosus and lupus nephritis.Frontiers in medicine · 2024Review
- Efficacy and Safety of New B Cell-Targeted Biologic Agent for the Treatment of Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2023Review
- Nanomaterials for antigen-specific immune tolerance therapy.Drug delivery and translational research · 2023Review
- Early and Late Response and Glucocorticoid-Sparing Effect of Belimumab in Patients with Systemic Lupus Erythematosus with Joint and Skin Manifestations: Results from the Belimumab in Real Life Setting Study-Joint and Skin (BeRLiSS-JS).Journal of personalized medicine · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
B cells are believed to be central to the disease process in systemic lupus erythematosus (SLE), making them a target for new therapeutic intervention. In recent years there have been many publications regarding the experience in SLE of B-cell depletion utilising rituximab, an anti-CD20 mAb that temporarily depletes B cells,reporting promising results in uncontrolled open studies and in routine clinical use. However, the two large randomised controlled trials in extra-renal lupus (EXPLORER study) and lupus nephritis (LUNAR study) failed to achieve their primary endpoints. Based on the clinical experience with rituximab this failure was somewhat unexpected and raised a number of questions and concerns, not only into the true level of benefit of B-cell depletion in a broad population but also how to test the true level of effectiveness of an investigational agent as we seek to improve the design of therapeutic trials in SLE. A better understanding of what went wrong in these trials is essential to elucidate the underlying reasons for the disparate observations noted in open studies and controlled trials. In this review, we focus on various factors that may affect the ability to accurately and confidently establish the level of treatment effect of the investigational agent, in this case rituximab, in the tw studies and explore hurdles faced in the randomised controlled trials investigating the efficacy of ocrelizumab, the humanised anti-CD20 mAb, in SLE. Further, based on the lessons learned from the clinical trials, we make suggestions that could be implemented in future clinical trial design to overcome the hurdles faced.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.