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Reumatol Clin. 2018 Dec 3. pii: S1699-258X(18)30192-X. doi: 10.1016/j.reuma.2018.08.012. [Epub ahead of print]

Effectiveness and Safety of Rituximab in Systemic Lupus Erythematosus: A Case Series Describing the Experience of 2 Centers.

[Article in English, Spanish]

Author information

1
Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Barcelona, España.
2
Servicio de Reumatología, Hospital del Mar/Parc de Salut-Mar/IMIM, Barcelona, España.
3
Servicio de Reumatología, Hospital del Mar/Parc de Salut-Mar/IMIM, Barcelona, España. Electronic address: tareto4@gmail.com.
4
Servicio de Reumatología, Hospital General de Cataluña, Barcelona, España.
5
Servicio de Reumatología, Hospital Comarcal Alt Penedés, Villafranca del Penedés, Barcelona, España.

Abstract

BACKGROUND:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs and systems. B cells have a critical role in the pathogenesis of SLE. Rituximab (RTX) is a drug composed of chimeric monoclonal antibodies against the CD20 protein, producing a depletion of B lymphocytes.

OBJECTIVE:

To analyze the effectiveness and safety of RTX in patients with SLE in clinical practice.

METHODS:

Collection of retrospective variables of the medical records of 20 patients with SLE treated with RTX in 2hospitals (Hospital de la Santa Creu i Sant Pau, and Hospital del Mar, in Barcelona, Spain). We evaluated demographic, clinical, serological and treatment variables.

RESULTS:

There was a statistically significant association in the following variables collected in the study before and after treatment: there was a decrease in the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (P<.001), erythrocyte sedimentation rate (P=.017), use of glucocorticoids (P=.025) and IgM values (P=.031), as well as an increase in the C4 values (P=.014) after treatment with RTX. A patient with SLE, antiphospholipid syndrome, complex comorbidity and multiorgan lupus involvement died after developing a septic process, months after receiving a single treatment cycle with RTX.

CONCLUSIONS:

Although RTX currently has no official indication approved for SLE, our data suggest that it may be effective in reducing the activity of the disease and as a steroid-sparing agent, with an acceptable safety profile. However, larger follow-up periods with a greater number of patients are needed to solve the remaining doubts about the use of RTX in SLE.

KEYWORDS:

Autoimmune diseases; B-lymphocytes; Efectividad; Effectiveness; Enfermedades autoinmunes; Linfocitos B; Lupus eritematoso sistémico; Rituximab; Safety; Seguridad; Systemic lupus erythematosus

PMID:
30522941
DOI:
10.1016/j.reuma.2018.08.012
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