CASE REPORTS - Rituximab in the treatment of inflammatory myopathies

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Clin Exp Rheumatol. 2009 Nov-Dec;27(6):1009-16.

Rituximab in the treatment of dermatomyositis and other inflammatory

myopathies. A report of 4 cases and review of the literature.

Rios Fernández R, Callejas Rubio JL, Sánchez Cano D, Sáez Moreno JA,

Ortego Centeno N.

Autoinmune Diseases Unit, Hospital Clínico San Cecilio, Granada, Spain.

Abstract

OBJECTIVE: Rituximab is an anti-CD20 monoclonal antibody targeting B

cells, which has been used with success in a wide variety of

autoimmune diseases. The experience with this drug in patients with

inflammatory myopathies (IM), nonetheless, is still limited. We review

the literature and highlight several aspects in relation to therapy

with rituximab in IM.

METHODS: We performed a research in the MEDLINE DATABASE. All cases

identified from the literature research and cases diagnosed in our

Unit were included in the analysis.

RESULTS: We identified 49 patients with IM treated with rituximab in

the review of the literature carried out (31 female; 18 male),

including our patients. Dermatomyositis (DM) was the most common

disorder for which rituximab treatment was administered (69.4%). The

other diseases treated included polymyositis (PM) 16.3%,

antisynthetase syndrome (AS) 8.2%, one case with anti-SRP-syndrome and

other with juvenile dermatomyositis. The median time to diagnosis was

48 (0.75-480) months. Sixty-five per cent (65.3%) of patients

presented with skin manifestations, 89.8% with muscle weakness, 7.3%

with arthritis, 16.3% with interstitial lung disease, and 7.3% with

cardiomyopathy. Seventy-one (71.4%) of the patients received only one

course of rituximab, 18.4% two courses, 4.1% three, 2% four and only

4.1% five. We have observed both among our patients and those reported

in the literature a high rate of response to rituximab, 75% of our

patients and 72.5% of those described in the literature showed a good

response. The median time free of symptoms between two courses was 12

(6-19) months. Rituximab was generally well tolerated by all patients,

with no serious adverse events. Most of the adverse events reported

were mainly infections, particularly respiratory tract infections.

CONCLUSIONS: It is our belief that rituximab may be an optimal

therapeutic choice for inflammatory myopathies. Nevertheless, there is

a need for additional studies in order to assess the optimal regimen

of treatment in the different subsets, as well as the initial dose,

combination of treatments and re-treatment schedule.

PMID: 20149324

http://www.ncbi.nlm.nih.gov/pubmed/20149324

Not an MD