Eight patients with refractory lupus nephritis received rituximab after failing standard sequential therapy and were followed for 104 weeks after the infusion. One patient died secondary to a complicated pregnancy but had stable renal function. Three patients received a re-infusion of rituximab approximately 12 months apart due to a renal flare; during the second year of follow-up, those patients progressed toward ESRD. The four remaining patients demonstrated improvements in SLEDAI score, CrCl, and proteinuria with maintenance of their standard immunosuppressive therapy and did not require a re-infusion of rituximab. Although rituximab as induction therapy for refractory lupus nephritis has been shown to have a good response, its efficacy in long-term assessments demonstrates disappointing results.

BackgroundCurrent strategies for treatment of RA promotes early use of synthetic (s-)DMARDs, their combination, or biologic (b-)DMARDs to achieve remission or low-disease activity. However, such strategies are related to a wide variety of adverse effects, from mild to life threatening. Infections could be detected more frequently among patients with b-DMARDs, although comorbidities, steroid use, chronic accumulated damage, or disease activity could bias such conclusions.ObjectivesTo investigate the frequency and severity of infections comparing RA patients users of s-DMARDs or b-DMARDs in a long-term period.MethodsPatients were selected from our RA Clinic. Those with at least 5 years using b-DMARD were compared with patients on s-DMARD, each one matched by disease duration, age, and comorbidities in a 1:1 ratio. Demographic features, disease characteristics, number and nature of infections during the follow-up, as well as disease activity, and treatment were recorded. Infections were considered as severe when it required hospitalisation or intravenous antibiotics. Comparison between groups was made with X2 or t-test as required.ResultsA total of 200 patients were prospectively assessed, 100 per group, mean age was 63.5±12.03 year-old, 91% were female, 78% were RF or ACPA positive, 20% had diabetes mellitus, and 3% other relevant comorbidities. When patients starting the use of b-DMARD, they had more active disease than those in the s-DMARD group (DAS28=4.99±1.5 vs. 3.91±1.2; p=0.01). Throughout 5 years of follow-up, there were 18 episodes of severe infections in the b-DMARDs group, and 2 episodes in the s-DMARD group (p=0.01); number of non-severe infections was 569 vs. 577 in such period, respectively (p=NS). No association was observed between severe infections and presence of diabetes mellitus, cumulative annual dose of prednisone, or DAS28, which did not differ in any other measure between groups. Sixteen patients in b-DMARD had severe infections: 6 acute pyelonephritis, 4 pneumonia, 4 acute bronchitis, 1 infectious diarrhoea, 1 emphysematous cystitis, 1 septic arthritis, and 1 haemorrhagic dengue compared with two severe infections in the s-DMARDs group: 1 pneumonia and 1 infectious diarrhoea. Median of hospitalisation days was 4.5, and no deaths were recorded. Infectious agents isolated were E. coli, C. albicans, Salmonella sp., and P. aeruginosa. The most frequent non-severe infections were upper respiratory disease, urinary tract infection, herpes zoster, acute diarrhoea, and bacterial vaginosis. Notoriously, 11 episodes of severe infection occurred in the first 2 years of b-DAMRD use (7 in first, and 4 in second year), the other 7 in remaining 3 years. b-DMARDs more frequently used were etanercept, rituximab, adalimumab, certolizumab pegol, and tocilizumab, without association between severe infections and any biologic agent.Abstract AB0423 – Figure 1Conclusionsb-DMARDs use in our setting, combined with low dose methotrexate, reach higher frequency of severe infections than s-DMARDs, irrespective of comor...