RESEARCH - Should rituximab be considered as the first-choice treatment for severe autoimmune rheumatic diseases?

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Clin Rev Allergy Immunol. 2008 Feb;34(1):124-8.

Should Rituximab be Considered as the First-Choice Treatment for

Severe Autoimmune Rheumatic Diseases?

Galarza C, Valencia D, Tobón GJ, Zurita L, Mantilla RD, Pineda-Tamayo

R, Rojas-Villarraga A, Rueda JC, Anaya JM.

Unidad de Enfermedades Reumáticas y Autoinmunes (UNERA), Hospital

Monte Sinai, Cuenca, Guayaquil, Ecuador.

The present study aimed to assess the tolerance and efficacy of

rituximab (RTX), a chimeric IgG1 monoclonal antibody directed against

the CD20 receptor present in B lymphocytes, in patients with

autoimmune rheumatic diseases (AIRD). For this purpose, patients

treated with RTX and their respective clinical charts were

comprehensively examined. Indications for treatment were a refractory

character of the disease, inefficacy or intolerance of other

immunosuppressors. Activity indexes (SLEDAI, DAS28, and specific

clinical manifestations) were used to evaluate efficacy. Serious side

effects were also recorded. Seventy-four patients were included.

Forty-three patients had systemic lupus erythematosus (SLE), 21 had

rheumatoid arthritis (RA), 8 had Sjögren's syndrome (SS), and 2 had

Takayasu's arteritis (TA). RTX was well-tolerated in 66 (89%)

patients. In 8 patients (SLE = 3, SS = 3, RA = 2), serious side

effects lead to discontinuation. The mean follow-up period was 12 +/-

7.8 (2-35) months. The efficacy of RTX was registered in 58/66 (87%)

patients, of whom 36 (83%) had SLE, 18/21 (85%) had RA, 3/8 (37%) had

SS, and 1 had TA. The mean time of efficacy was 6.3 +/- 5.1 weeks. A

significant steroid-sparing effect was noticed in half of the

patients. These results add further evidence for the use of RTX in

AIRD. Based on its risk-benefit ratio, RTX might be used as the

first-choice treatment for patients with severe AIRD.

PMID: 18270866

http://www.ncbi.nlm.nih.gov/pubmed/18270866

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