Estimated Time of Completion

XXX

Description

In this update, we review the effects that B-cell-directed therapies may have on the immunocompetence of patients with autoimmune disease and describe immunologic precautions regarding rituximab treatment and screening, immunization, and prophylaxis in patients with rheumatoid arthritis (RA). We discuss our current understanding of CD27 and its impact on the cellular memory of human memory B cells. Understanding how the clinical response to B-cell-directed therapies may vary given differing levels of memory B cells in patients being treated for RA may improve our ability to target treatment to patient characteristics. Updates on clinical trials of B-cell-directed therapies include a critical evaluation of the results of long-term radiographic studies of rituximab for the treatment of RA, as well as the current nonrandomized clinical experience with rituximab for the treatment of systemic lupus erythematosus (SLE). The latest available information for the clinician on the results from randomized phase II and phase III clinical trials in SLE for multiple B-cell-directed therapies including rituximab, belimumab, and epratuzumab is also reviewed.

Objectives

At the conclusion of this activity, the participants will be able to:

1. Cite the key clinical features of recent advances in B-cell biology as they relate to autoimmune rheumatic diseases (ARDs).
2. Review advances in molecular biology that contribute to the understanding of the integrated immune response and the pathogenesis of autoimmune rheumatic diseases.
3. Discuss the most recently published clinical data relating to the usage of B-cell-directed therapies for RA.
4. Examine current approaches to the usage of B-cell-directed therapeutics in RA and explore strategies to optimize treatment outcomes, including efficacy and safety.
5. Identify current approaches and clinical challenges in using B-cell-directed therapies in SLE, vasculitis, and ARDs.
6. Describe recent advances in the development of novel B-cell-directed therapies.
7. Describe the role of the allied health professional in the overall management of patients on B-cell-directed therapies from the perspective of patient counseling, assessing risks and benefits, administering and monitoring drug therapies, and assessment and management of drug-related toxicities.

Target Audience

Rheumatologists, immunologists, clinical researchers, and allied health care professionals, including nurses, nurse practitioners, and physician assistants, who care for patients with autoimmune diseases.

Accreditation

The Cleveland Clinic Foundation Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Cleveland Clinic Foundation Center for Continuing Education designates this educational activity for a maximum of XX AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity may be submitted for American Osteopathic Association Continuing Medical Education credit in Category 2.

Activity Director / Faculty

Leonard H. Calabrese, DO
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
RJ Fasenmyer Chair of Clinical Immunology
Department of Rheumatic and Immunologic Diseases
Cleveland, Ohio

Editorial Board

Marc D. Cohen, MD
Professor of Medicine
Chief of Rheumatology
National Jewish Medical
  and Research Center
Denver, Colorado

Jonathan Kay, MD
Associate Clinical
  Professor of Medicine
Harvard Medical School
Director of Clinical Trials
Rheumatology Unit
Massachusetts General
  Hospital
Boston, Massachusetts

Gregg J. Silverman, MD
Director, Laboratory of
  B-Cell Immunology
Professor of Medicine
Division of Rheumatology,
  Allergy, and Immunology
University of California
  San Diego School of
  Medicine
La Jolla, California

Faculty Disclosure

In accordance with the Standards for Commercial Support issued by the Accreditation Council for Continuing Medical Education (ACCME), The Cleveland Clinic Foundation Center for Continuing Education requires resolution of all faculty conflicts of interest to ensure CME activities are free of commercial bias.

The following faculty have indicated they may have a relationship, which in the context of their presentation(s), could be perceived as a potential conflict of interest:

The Cleveland Clinic Foundation Center for Continuing Education acknowledges an educational grant for support of this activity from:

Genentech, Inc. and Biogen Idec.