High-sensitivity flow cytometry in rheumatoid arthritis shows that early B-cell subset depletion is linked to 5-year rituximab response, while failure to deplete B cells occurs early in subsequent poly-refractory disease
Authors' conclusion
2W plasmablast depletion on HSFC is strongly linked to 5-year RTX retention, while incomplete memory B-cell depletion characterises poly-refractory RA.
Study context
- Population
- Rituximab (RTX)-treated rheumatoid arthritis (RA) adults, from good initial RTX responders to poly-refractory RA
- Participants
- 232 adults
- Outcome
- Complete depletion of B-cell subsets (naïve, memory B cells, plasmablasts; counts < 0.1 cells/µL) on high-sensitivity flow cytometry (HSFC), and association with 1-year response and 5-year RTX persistence
- Follow-up
- 2 weeks
Methodological detailssingle-centre, real-world cohort
- Single-centre
- Real-world cohort
Main finding
As reported in the abstract
- 2W complete depletion, naïve B cells
- 91%
- 2W complete depletion, memory B cells
- 92%
- 2W complete depletion, plasmablasts
- 69%
- Higher 2W plasmablast counts and 1-year response, OR
- 0.50 (95%CI 0.32-0.75; P = .001)
- Higher 2W plasmablast counts and 5-year RTX persistence, OR
- 0.48 (95%CI 0.30-0.79; P = .004)
Observational data: associations, not effects.
Further findings
Poly-refractory RA: 2W memory B-cell counts and increasing refractoriness · 2 weeks
- Memory B-cell counts and increasing refractoriness, OR
- 1.9 (95%CI 1.3-2.9; P = .003)
- Poly-refractory RA (n=31; 13%) showed higher 2W memory B-cell levels
B-cell trajectories across multiple RTX cycles
- Sustained suppression of memory B cells and plasmablasts in patients showing RTX persistence
Original publication
High-sensitivity flow cytometry in rheumatoid arthritis shows that early B-cell subset depletion is linked to 5-year rituximab response, while failure to deplete B cells occurs early in subsequent poly-refractory disease. Ann Rheum Dis. Published 11 August 2026. doi:10.
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