Abstract
Lobenzarit (CCA) has been widely used in Japan for the treatment of RA as one of DMARDs. Considerable patient to patient variation of its effectiveness is observed with unclarified mechanism. In this study, clinical efficacy of lobenzarit (CCA) and alteration of immunological parameters during 6 months of treatment were examined in 22 patients on early stage of RA who fulfilled the revised ARA criteria. The patients received no immuno-modulating agents except CCA and those taking more than 5 mg/day of prednisolone were excluded from the study. Alteration of lymphocyte subsets measured by using monoclonal antibodies and the fluorescence-activated cell sorter, PHA-stimulated cytokine (IL-2 and gamma-IFN) production, serum levels of immunoglobulins and various auto-antibodies were monitored in conjunction with clinical assessment during the course of treatment.
The patients were clinically classified into responders (10/22) and nonresponders to CCA (12/22) . Those who responded well to CCA showed normalization of CD20-positive B cells in association with decreased levels of serum immunoglobulins, immune complexes, and antibodies to double-stranded DNA. These patients showed no significant alteration of T cell subsets and cytokine production prior to and after CCA therapy. In contrast, nonresponders demonstrated to be defective in cytokine production throughout the treatment.
These results may indicate that CCA exerts its anti-rheumatic effect through B cell level.
