Long‐term comparison of rituximab treatment for refractory systemic lupus erythematosus and vasculitis: Remission, relapse, and re‐treatment
Top Cited Papers
- 31 August 2006
- journal article
- clinical trial
- Published by Wiley in Arthritis & Rheumatism
- Vol. 54 (9), 2970-2982
- https://doi.org/10.1002/art.22046
Abstract
Objective Current treatments for systemic lupus erythematosus (SLE) and vasculitis contribute to mortality and incapacity and are only partially effective; thus, newer therapies are clearly needed. Depletion of B cells has led to disease control in patients with autoimmune disorders. We sought to assess the long‐term efficacy and safety of a B cell–depleting therapy in patients with SLE and patients with vasculitis. Methods In a prospective study with a median followup of 24 months, 11 patients with active or refractory SLE and 11 patients with active or refractory antineutrophil cytoplasmic antibody–associated vasculitis (AAV) received a course of therapy with rituximab (an anti‐CD20 monoclonal antibody) along with a single dose of intravenous cyclophosphamide. Results Remission followed rapid B cell depletion, with response rates of 100% among the 11 patients with SLE (6 patients had a complete response, and 5 patients had a partial response) and 91% among the 11 patients with AAV (9 patients had a complete response, and 1 patient had partial remission). A renal response occurred in all 6 patients with lupus nephritis. Clinical improvement was accompanied by significant reductions in the daily dose of prednisolone. Relapse occurred in 64% of the patients with SLE and in 60% of those with AAV. B cell return preceded relapse in the majority of patients, and further treatment with rituximab proved effective. IgG and IgM levels were maintained in the normal range. The incidence of infective complications was low; however, infusion reactions were common, and human antichimeric antibodies developed in 5 of 14 patients. Conclusion B cell depletion offers the prospect of sustained disease remission and improved disease control combined with low toxicity in patients with active or refractory SLE or AAV. Relapse following treatment is common, but re‐treatment is rapidly effective.Keywords
This publication has 45 references indexed in Scilit:
- B Cell-Driven Lymphangiogenesis in Inflamed Lymph Nodes Enhances Dendritic Cell MobilizationImmunity, 2006
- B-cell depletion in the treatment of patients with systemic lupus erythematosus: a longitudinal analysis of 24 patientsRheumatology, 2005
- Nine patients with anti‐neutrophil cytoplasmic antibody‐positive vasculitis successfully treated with rituximabJournal of Internal Medicine, 2005
- Remission of proliferative lupus nephritis following B cell depletion therapy is preceded by down‐regulation of the T cell costimulatory molecule CD40 ligand: An open‐label trialArthritis & Rheumatism, 2005
- B cell depletion as a novel treatment for systemic lupus erythematosus: A phase I/II dose‐escalation trial of rituximabArthritis & Rheumatism, 2004
- Short-lived Plasmablasts and Long-lived Plasma Cells Contribute to Chronic Humoral Autoimmunity in NZB/W MiceThe Journal of Experimental Medicine, 2004
- Hypocomplementemic urticarial vasculitis with angioedema, a rare presentation of systemic lupus erythematosus: rapid response to rituximabJournal of the American Academy of Dermatology, 2003
- An open study of B lymphocyte depletion in systemic lupus erythematosusArthritis & Rheumatism, 2002
- Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosusArthritis & Rheumatism, 1997
- Nomenclature of Systemic VasculitidesArthritis & Rheumatism, 1994