RESEARCH - A retrospective 7-year analysis of the use of B-cell depletion in SLE: the first 50 patients

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Arthritis Rheum. 2009 Mar 30;61(4):482-487.

A retrospective seven-year analysis of the use of B cell depletion

therapy in systemic lupus erythematosus at university college london

hospital: The first fifty patients.

Lu TY, Ng KP, Cambridge G, Leandro MJ, JC, Ehrenstein M, Isenberg DA.

University College of London, London, UK.

OBJECTIVE: To describe the 6-month clinical outcome and the long-term

safety profile of B cell depletion therapy (BCDT) in 50 patients with

active systemic lupus erythematosus (SLE), who were nonresponsive or

poorly responsive to conventional immunosuppression.

METHODS: All except 4 of 50 patients with active SLE received 1 gm of

rituximab, 750 mg of cyclophosphamide, and 100-250 mg of

methylprednisolone, administered on 2 occasions 2 weeks apart, to

achieve B cell depletion. Clinical outcome was assessed using the

British Isles Lupus Assessment Group (BILAG) activity index and serial

serologic measurements of disease activity. Remission was defined as a

change from a BILAG A or B score to a C or D score in every organ

system. Partial remission was a change from a BILAG A or B score to a

C or D score in at least 1 system, but with the persistence of 1 score

of A or B in another system. No improvement was defined as a BILAG A

or B score that remained unchanged after treatment.

RESULTS: Of the 45 patients available for followup at 6 months, 19

patients (42%) achieved remission, and 21 patients (47%) reached

partial remission after 1 cycle of BCDT (mean followup 39.6 months).

BCDT resulted in a decrease in median global BILAG scores from 12 to 5

(P < 0.0001) and median anti-double-stranded DNA antibody titers from

106 to 42 IU/ml (P < 0.0001), and an increase in the median C3 level

from 0.81 to 0.95 mg/liter (P < 0.02) at 6 months. Five serious

adverse events were observed.

CONCLUSION: BCDT is an effective treatment for patients with active

SLE whose disease has failed to respond to standard immunosuppressive

therapy. Although the safety profile of BCDT is favorable, ongoing

monitoring is required.

PMID: 19333973

http://www.ncbi.nlm.nih.gov/pubmed/19333973

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