239 Why do some patients with systemic lupus erythematosus fail to respond to B cell depletion using rituximab?

Abstract

The Centre for Rheumatology has treated 165 lupus patients with Rituximab since 2000. Our aim was to identify patients who failed to respond, identify any obvious distinguishing features, and to optimize individual patient treatment. Methods We reviewed all 165 lupus patients treated with Rituximab and reviewed the data up to 6 months after treatment. We excluded those who developed allergic reactions, had discoid lupus only or were lost follow-up. We assessed patients with active disease after 6 months, using the British Isles Lupus Assessment Group (BILAG) disease activity scores. Those patients whose A and B scores did not decrease, were deemed to have failed to respond. Results 144 patients were included in the final analysis. The median disease duration was 6.68 (IQR 2.32-11.90) years. 13.9% of the patients failed to decrease their BILAG scores. Two of the 144 patients died during the 6 months after treatment. The median BILAG at baseline was lower in the failure group (8.50, SD 6.00-12.75) at the time of treatment as opposed to those patients who improved (17, SD12.0-23.0) (p<0.001). We found that patients with renal involvement failed less often than those without it (p=0.021). No other significant differences were observed. Conclusions Patients with a lower BILAG score are less likely to benefit from RTX treatment. Patients with renal involvement were less likely to fail to respond to RTX. We could not identify other features predictive of failure.

Efficacy, Safety, and Pharmacodynamic Effects of the Bruton’s Tyrosine Kinase Inhibitor Fenebrutinib (GDC‐0853) in Systemic Lupus Erythematosus: Results of a Phase II, Randomized, Double‐Blind, Placebo‐Controlled Trial

“…Only one targeted agent, belimumab, has been approved for the treatment of SLE in the past 60 years (4,5). Although not formally approved, rituximab, a monoclonal anti-CD20 antibody, is also used to treat diverse aspects of SLE (6,7).…”

The landscape of systemic lupus erythematosus in Brazil: An expert panel review and recommendations

“…58,59 In contrast, rituximab utility is widely established for patients with severe disease refractory to conventional management, especially in cases with renal involvement (also musculoskeletal, hematological, cutaneous, and neurological involvement). [60][61][62][63] Rituximab reduces steroid dosage in more than 50% of patients with higher dose of steroids and disease activity. 64 Belimumab, a monoclonal antibody, became the only biologic agent approved for SLE treatment after reaching primary efficacy goals in the BLISS trials.…”

Rituximab – The first twenty years

“…They reported a slightly higher rate of response in patients given the four-weekly regime (94% versus 3%; p = 0.048). In a more recent single-centre study, we have reviewed the first 165 patients with lupus treated with rituximab 15 the clear majority – (more than 50% not having nephritis) were treated by the two x 1 g infusion regime. Using the British Isles Lupus Assessment Group (BILAG) Disease Activity Assessment with the classic A-E scores converted into numbers using the A = 12, B = 5, C = 1, D/E = 0 scoring 16 we reported that 73% of these patients showed a reduction in their BILAG score by 5 points or more, sustained for up to 6 months post-treatment.…”