Low-dose rituximab therapy in steroid-refractory thrombocytopenia due to systemic lupus erythematosus

Ilizaliturri-Guerra, Octavio; Uriarte-Botello, Rodolfo; Pineda-Sic, R.; Serna-Peña, Griselda; Elizondo, Mario Alberto Garza; Galarza‐Delgado, Dionicio Ángel; Leal‐Bramasco, Ana Sofía; Elizondo-Solís, César Vidal; Santoyo-Fexas, L.; Villarreal-Alarcón, Miguel Ángel

doi:10.1007/s00296-020-04668-4

Cited by 14 publications

(8 citation statements)

References 16 publications

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“…Stimulation by estrogen, genetic, environmental, infectious, and endocrine factors leads to a decrease in T lymphocytes and a proliferation of B cells, which is consequently associated with the direct binding of autoantibodies to the tissue cells and subsequent local tissue damage and inflammatory reactions [ 12 ]. Currently, glucocorticoids are the main drug for the treatment of the disease [ 13 ]. However, long-term administration of high-dose glucocorticoids increases the risk of adverse drug reactions and drug dependency, while reduction of the drug dose is presumably associated with relapse [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy of Gandakang Tablets plus Methylprednisolone in Patients with Systemic Lupus Erythematosus

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To evaluate the clinical efficacy of Gandakang tablets plus methylprednisolone in patients with systemic lupus erythematosus (SLE). Methods. From February 2015 to February 2019, 60 eligible patients with SLE were recruited and assigned via the random number table method at a ratio of 1 : 1 to receive either methylprednisolone (control group) or Gandakang tablets plus methylprednisolone (observation group). The primary endpoint was clinical efficacy, and the secondary endpoints included Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, immunoglobulin (Ig), inflammatory factor levels, and adverse events. Results. Gandakang tablets plus methylprednisolone were associated with a significantly higher treatment efficacy versus methylprednisolone alone ( P < 0.05 ). Gandakang tablets plus methylprednisolone resulted in significantly lower SLEDAI scores and lower levels of IgG, IgM, IgA, tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), and interleukin-6 (IL-6) versus single medication of methylprednisolone ( P < 0.05 ). The two groups showed a similar incidence of adverse events ( P > 0.05 ). Patients given Gandakang tablets plus methylprednisolone had higher mental health, emotional role, physical role, social functioning, and bodily pain scores versus those receiving the monotherapy of methylprednisolone ( P < 0.05 ). Conclusion. Gandakang tablets plus methylprednisolone is effective in the treatment of SLE by enhancing the patients’ immunity, mitigating the inflammatory response, eliminating negative emotions, and improving their quality of life.

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Section: Discussionmentioning

confidence: 99%

Clinical Efficacy of Gandakang Tablets plus Methylprednisolone in Patients with Systemic Lupus Erythematosus

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Some clinicians have reported several cases of good responses to low-dose RTX in patients with lupus-induced thrombocytopenia. 12 In an earlier study at our center, 70% (7/10) OR was achieved at 24 weeks in SLE-associated thrombocytopenia patients who received RTX at a dose of 100 mg/week for 4 weeks. 11 Thus, our modified low-dose RTX regimen achieved a similar response rate compared with previously reported standard-dose (375 mg/m 2 /week for 4 weeks or 1000 mg on days 1 and 15) and low-dose (100 mg/week for 4 weeks) regimens.…”

Section: Discussionmentioning

confidence: 81%

“…Although the intravenous (IV) dosage of 375 mg/m 2 per week for four consecutive weeks in patients with ITP or refractory SLE associated with major organ involvement showed satisfactory responses in previous studies, 10 a low-dose regimen (100 mg IV per week for 4 weeks) has been shown to minimize the side effects and reduce costs. 11 , 12 The low-dose RTX regimen in the study by Chen et al is associated with a good response rate (as high as 70% at week 24). 11 , 12 To find a safer and more economical therapy with similar or better effectiveness, we conducted this exploratory intervention study to test for the efficacy of a modified low-dose RTX regimen in the management of SLE-associated refractory ITP.…”

Section: Introductionmentioning

confidence: 99%

“… 11 , 12 The low-dose RTX regimen in the study by Chen et al is associated with a good response rate (as high as 70% at week 24). 11 , 12 To find a safer and more economical therapy with similar or better effectiveness, we conducted this exploratory intervention study to test for the efficacy of a modified low-dose RTX regimen in the management of SLE-associated refractory ITP.…”

Section: Introductionmentioning

confidence: 99%

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A modified regimen of low-dose rituximab therapy for patients with refractory immune thrombocytopenia associated with systemic lupus erythematosus

Zhang

Jiang

Wang

et al. 2021

Therapeutic Advances in Chronic Disease

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Background: Severe and refractory immune thrombocytopenia (ITP) affects the life expectancy of patients with systemic lupus erythematosus (SLE) and poses a challenge in their clinical management. This intervention study employed a small sample size to evaluate the efficacy and safety of a modified low-dose rituximab (RTX) regimen in patients with SLE-associated refractory ITP. Methods: Eight patients with severe SLE-associated refractory ITP were enrolled in this intervention study. They received an infusion of intravenous RTX (200 mg) on days 1 and 15. The dose of corticosteroids (prescribed previously) was gradually tapered, and immunosuppressants were withdrawn. Patients were followed up at 1, 3, 6, and 12 months; platelet counts, other laboratory indicators, and side effects were recorded. We used intention-to-treat analysis to calculate the response rate. Results: Seven participants (87.5%) completed the study. At 1 month, two patients (25.0%) achieved partial response (PR); the PR rate increased to 87.5% at 3 months. At 6 months, three patients (37.5%) achieved complete response (CR). However, the CR rate dropped to 25.0% at 12 months. The overall responses (ORs) were 25.0% (2/8), 87.5% (7/8), 75.0%(6/8), and 75.0%(6/8) at 1, 3, 6, and 12 months, respectively. Two patients developed a mild infusion reaction and one discontinued the study due to herpes zoster virus infection and an allergic reaction 2 weeks after the first dose of RTX. Conclusion: Modified low-dose RTX therapy (two infusions of 200 mg every 2 weeks) could be a promising new option for patients with SLE-associated refractory ITP with a satisfactory response rate.

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“…However, regarding efficacy of low-dose (100 mg weekly, 4 doses) rituximab, very limited data are available. Only few studies have been conducted regarding the potential role of low-dose rituximab in SLE, and these are only about lupus-induced thrombocytopenia [ 21 , 22 ]. As low-dose intravenous rituximab has played a role in inducing sustained remission of lupus-induced GI vasculitis and pancytopenia, as seen in our patient, therefore, it can be suggested that low-dose rituximab has added advantages of cost-effectiveness and limited side effect profile and can be utilized as an effective option for refractory systemic lupus and lupus-induced pancytopenia.…”

Section: Discussionmentioning

confidence: 99%

Dramatic Response of Lupus Enteritis, Nephritis, and Pancytopenia to Plasmapheresis and Rituximab

Aftab

Saleem

Abbas

et al. 2022

Case Reports in Gastrointestinal Medicine

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Background. Although lupus enteritis is a rare manifestation of systemic lupus erythematosus yet results in significant distress. This disorder contributes to diagnostic and therapeutic dilemma leading to enhanced mortality. Case Description. We report a case history of a 29-year-old female who presented with severe abdominal pain, watery stools, and vomiting, and later on, she developed pancytopenia and renal impairment. On intensive workup, diagnosis of lupus-associated enteritis, nephritis, and pancytopenia was discovered. She improved drastically on initiation of plasmapheresis followed by low-dose intravenous rituximab. One year posttreatment, she remained in complete remission. Conclusion. From this case, it can be suggested that in a young female with intractable abdominal pain, the remote possibility of lupus enteritis must be kept in mind. Besides this, plasmapheresis can have a potential role in refractory lupus enteritis. Furthermore, low-dose intravenous rituximab can be a safe and cost-effective treatment option in achieving sustained remission of clinical and laboratory parameters in lupus enteritis.

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Low-dose rituximab therapy in steroid-refractory thrombocytopenia due to systemic lupus erythematosus

Cited by 14 publications

References 16 publications

Clinical Efficacy of Gandakang Tablets plus Methylprednisolone in Patients with Systemic Lupus Erythematosus

Clinical Efficacy of Gandakang Tablets plus Methylprednisolone in Patients with Systemic Lupus Erythematosus

A modified regimen of low-dose rituximab therapy for patients with refractory immune thrombocytopenia associated with systemic lupus erythematosus

Dramatic Response of Lupus Enteritis, Nephritis, and Pancytopenia to Plasmapheresis and Rituximab

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