CD4 and rheumatoid arthritis: It has been proposed that Rituximab has an effect on CD4+ cells, inducing substantial T-cell depletion in RA.124 Rituximab plus MTX demonstrated significant and sustained effects on reducing joint damage progression in RA patients who had a previously inadequate response to TNFi.125 The Rituximab biosimilars include the drugs BCD-020, Maball, and MabTas, which have been approved by some countries.113 The side effects reported include hypogammaglobulinemia, infection, late-onset neutropenia, and mucocutaneous reactions.