Anti-CD20 therapy in patients with refractory systemic lupus erythematosus: a longitudinal analysis of 52 Hispanic patients

Abstract

The objective of this study was to investigate the efficacy and safety of anti-CD20 treatment in Hispanic patients with refractory systemic lupus erythematosus and to determine whether baseline parameters predict disease flare. Fifty-two patients with systemic lupus erythematosus, 13 with active lupus nephritis, eight with thrombocytopenia, three with leukocytopenia, 25 with severe musculoskeletal involvement and three with skin involvement) refractory to conventional therapy were treated with anti-CD20 treatment (rituximab; MabThera, Roche) plus ongoing immunosuppressive treatment. Disease activity was assessed monthly using the SLEDAI validated for the Mexican population with a follow-up period of 6 months. At 6 months of follow-up, significant clinical improvements were detected, with a reduction in the global SLEDAI validated for the Mexican population score. Five of the 13 patients with lupus nephritis (38.4%) had a complete renal response and five (38.4%) had a partial response. Rituximab was also effective in patients with autoimmune thrombocytopenia, inducing a significant increase in platelet counts (p = 0.012). Nineteen of 25 patients with severe musculoskeletal involvement had remission of arthritis. Only one of the three patients with skin involvement had no lesions at 6 months. Rituximab treatment also allowed a reduction of the oral prednisone dose in the majority of patients. No baseline predictors of flare were found. Treatment was discontinued after the first infusion in two patients due to serum sickness and in another due to pulmonary infection. In conclusion, the addition of rituximab to conventional immunosuppressive therapy may be an effective strategy for lupus nephritis, autoimmune thrombocytopenia and inflammatory polyarthritis in patients with refractory systemic lupus erythematosus.

Long-term efficacy of anti-CD20 antibodies in refractory lupus nephritis

“…Importantly, patients with renal involvement demonstrated a therapeutic response of 91%, but despite these encouraging results, the interpretation of these studies should be considered in the context of their inherent bias [7]. Similar results have been reported by García-Carrasco [8] in patients with refractory lupus; however, their patients had a moderate degree of disease activity at the time of infusion, as measured by the Mex-SLEDAI system [9]. Moreover, B-cell depletion therapy has been used exclusively for the treatment of lupus nephritis, even in the cases of advanced glomerular lesions [10].…”

B-cell-targeted therapies in systemic lupus erythematosus

“…In these observational studies, patients with active or refractory SLE that was unresponsive to conventional immunosuppressive agents were given rituximab. The overall response rates range from 55% to 87%, and significant responses have been documented in lupus nephritis [90][91][92][93] and neuropsychiatric lupus. 94 The most common adverse events were infections, with cutaneous infections and pneumonia being more frequent.…”

Nefropatía lúpica

“…Los estudios "de la vida real" [92][93][94][95][96][97][98][99][100] , en su mayoría de cohortes, muestran resultados diferentes al estudio LUNAR; la mayoría de los pacientes incluidos recibieron RTX por falla al manejo inmunosupresor, algunos en combinación con MMF o CFM y otros como monoterapia. La principal conclusión de estos estudios es que RTX estaría indicado en casos refractarios de NL proliferativa.…”