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Rituximab Decreased Disease Activity in Patients with Severe or Refractory SLE
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Treatment of systemic lupus erythematosus with rituximab effectively decreased disease activity with a low incidence of adverse effects in patients with severe or refractory disease, according to results of a long-term study at a single center.
Researchers assessed the clinical outcomes of 115 patients (93.9% women) with systemic lupus erythematosus treated with rituximab between June 2000 and December 2013 by determining British Isles Lupus Assessment Group (BILAG) scores, anti-double standard DNA and C3 levels before and 6 months after rituximab treatment. Patients had a mean age of 26 years at the time of diagnosis and a mean disease duration of 91.96 months at first rituximab treatment.
Results showed a BILAG score variation of approximately -11.26 at 6 months after the first rituximab treatment, with a complete response identified in 40% of patients and a partial response in 27% of patients. Researchers found C3 levels increased more than 25% in 36.5% of patients, while double standard DNA levels decreased more than 50% in 33.5% of patients. According to results, 94% of patients achieved depletion of CD19+ cells. Overall, researchers detected hypogammaglobulinemia in 14.9% of patients with significant reduction for immunoglobulin M and immunoglobulin G levels.
Results showed severe infections occurred in 7% of patients, infusion-related reactions occurred in 3.5% of patients and hypersensitivity reactions occurred in 2.6% of patients. Repeated rituximab treatments occurred in 62 of 115 patients, according to results. Researchers noted 11 patients were deceased, with six patients who experienced cardiovascular events at the end of 14 years of follow-up.
“In spite of the failure of the two international trials of B cell depletion in [systemic lupus erythematosus] SLE to meet their endpoints, virtually everyone who has used rituximab in SLE agrees that it has a part to play; especially in ‘hard-to-treat’ patients,” study author David Isenberg, MD, FRCP, FAMS, academic director of rheumatology in the Department of Medicine at the University College London, told Healio.com/Rheumatology. “Our new report confirms that about 70% of patients whose lupus has been hard to treat will respond well to this treatment, whose benefits may last for several years. The treatment may be repeated safely and effectively, though vigilance is needed subsequently to monitor the immunoglobulin levels, B cell counts and infection risk.” – by Casey Tingle
Disclosure: Isenberg reports no relevant financial disclosures.
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