This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Reynolds, J. Articles by Gordon, C Search for Related Content PubMed PubMed Citation Articles by Reynolds, J. Articles by Gordon, C Social Bookmarking                         What's this?

Effects of rituximab on resistant SLE disease including lung involvement

Department of Rheumatology, City Hospital, Birmingham, West Midlands, UK

V Toescu

Department of Rheumatology, City Hospital, Birmingham, West Midlands, UK; Department of Rheumatology, Division of Immunity and Infection, University of Birmingham, Birmingham, UK

CS Yee

Department of Rheumatology, City Hospital, Birmingham, West Midlands, UK; Department of Rheumatology, Division of Immunity and Infection, University of Birmingham, Birmingham, UK

A Prabu

Department of Rheumatology, City Hospital, Birmingham, West Midlands, UK; Department of Rheumatology, Division of Immunity and Infection, University of Birmingham, Birmingham, UK

D Situnayake

Department of Rheumatology, City Hospital, Birmingham, West Midlands, UK

C Gordon

Department of Rheumatology, City Hospital, Birmingham, West Midlands, UK; Department of Rheumatology, Division of Immunity and Infection, University of Birmingham, Birmingham, UK

We present a retrospective review of 11 patients with refractory systemic lupus erythematosus (SLE) treated with rituximab after failing corticosteroids and at least one other immunosuppressive drug. We measured clinical response using the Classic British Isles Lupus Assessment Group (BILAG) index, serum complement and reduction in maintenance prednisolone dose. B cells were measured using flow cytometry, and lung function testing was used to assess severe pulmonary disease (three patients). The median patient age was 42 years (range, 25–64) with median disease duration 6 years (range, 2–12). In all, 10 of 11 patients responded initially, with median global BILAG reduction of 7.5 at 6 months (P = 0.007), with loss of all A and B scores by 7 months. Rituximab treatment was associated with normalisation of complement (C3 P = 0.008, C4 P = 0.018) and reduction in steroid requirement, median reduction 15 mg/day (P = 0.036). In 9 of 10 patients who responded, all other immunosuppressants were stopped. There was no significant difference in anti-dsDNA antibody titres in these responders, but they were negative or had low titres at baseline. B-cell depletion continued for median 4 months (range, 2–9), and disease flare occurred at a median 6.6 months (range, 1.5–23) and was preceded by B-cell recovery in all but two patients. Rituximab was beneficial in refractory SLE including severe neurological and cardiorespiratory disease by inducing disease remission, allowing withdrawal of other agents and reduction in steroid requirement. Rituximab appeared to stabilise and possibly improve progressive lung disease.

Key Words: B cells • lung disease • rituximab • SLE

Lupus, Vol. 18, No. 1, 67-73 (2009)
DOI: 10.1177/0961203308094653


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				D E Furst, E C Keystone, R Fleischmann, P Mease, F C Breedveld, J S Smolen, J R Kalden, J Braun, B Bresnihan, G R Burmester, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2009 Ann Rheum Dis, January 1, 2010; 69(Suppl_1): i2 - i29. [Full Text] [PDF]