@Jonathan Edwards
I see that a new paper published in January about RP titled: "Refractory Relapsing Polychondritis: Challenges and Solutions" has this to say in regards to the use/study of rituximab for RP.
"Relapsing polychondritis has not remained on the margins of history with the introduction of biologics in our therapeutic arsenal. The alleged autoimmune nature of this disease was a major argument to justify the use of targeted biological therapies in patients with relapsing polychondritis refractory to the conventional immunosuppressive agents. Given the evidence of T-helper cell infltration; the presence of antigen-antibody complexes in involved cartilage; the cellular humoral responses directed against type II collagen, matrilin, and other antigens in the sera; the frequency of HLA DR4; and the improvement after immunosuppressive therapy, it was logical to propose drugs blocking cellular pathways of immune responses and/or drugs targeted against B cells such as
rituximab or abatacept.
Furthermore, increased expression of cytokines in relapsing polychon- dritis including TNFα, IL 1, and IL 6, particularly during relapse, can justify the use of specifc inhibitors of these cytokines. However, no clinical trial is available to support an evidence-based medicine approach for the use of biologics in relapsing polychondritis.
Therefore, the use of biologics is currently based on the estimation of disease activity and severity.
Most of the biologics used and the strategies of treatment are borrowed from rheumatoid arthritis. The waltz with biologics was opened in 1991 with anti-CD4 monoclonal antibodies. A transient effcacy was observed in two patients with a rapid decline in circulating blood CD4 levels and a secondary return to normal levels more or less rapidly, without adverse event. It was not until the 2000s that watched a wave of publication on the effcacy of biologics in the management of relapsing polychondritis. Thus, anakinra, anti-TNFα (infiximab, etanercept, adali- mumab, certolizumab pegol), abatacept,
rituximab, and tocilizumab have been prescribed in many patients.
No clinical trials had been conducted with biologics in relapsing polychondritis. Five years after the recommendation was made, no randomized clinical trial has been conducted.
Only one study has clearly defned the endpoints during evaluation of the effects of
rituximab in nine patients. In this study, disease activity was compared in the 6 months preceding
rituximab administration and at 6 and 12 months after administration. Disease activity was evaluated on clinical features, CRP levels, thoracic CT scan, spirometry, corticosteroid regimen, and any change in immunosuppressive drugs." (link to the study below)
http://onlinelibrary.wiley.com/doi/10.1002/art.24366/full