Repeated B cell depletion in treatment of refractory systemic lupus erythematosus

Ng, Kristine

doi:10.1136/ard.2005.044487

Cited by 80 publications

(50 citation statements)

References 11 publications

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“…In addition, evidence for the direct participation of TRAbs and IGF-1r autoantibodies in GO pathogenesis suggests that rituximab, an agent that blocks CD20 ligation and the early phases of B cell maturation, might prove beneficial in the disease (35). A trial of rituximab therapy in patients with refractory systemic lupus erythematosus found improved disease activity with a significant decline in the levels of anti-dsDNA antibody levels (36)(37)(38). A similarly beneficial effect in patients with rheumatoid arthritis, improving rheumatoid factor levels and disease parameters, was seen following this therapy (39).…”

Section: Novel Approaches To Therapymentioning

confidence: 81%

Pathogenesis of Graves' Ophthalmopathy: The Role of Autoantibodies

Khoo

Bahn

2007

Thyroid

139

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The clinical manifestations of Graves' ophthalmopathy (GO) stem from a combination of increased orbital fat and extraocular muscle volume within the orbital space. Fibroblasts residing within these tissues are thought to be targets of autoimmune attack in the disease. Thyrotropin receptor (TSHr) mRNA and functional protein have been demonstrated in orbital fibroblasts from both normal individuals and GO patients, with higher levels present in the latter. Autoantibodies directed against TSHr or the insulin-like growth factor-1 (IGF-1) receptor have been implicated in GO pathogenesis. Evidence from our laboratory suggests that monoclonal TSHr autoantibodies (TRAbs) are potent stimulators of adipogenesis in GO orbital cells. Therefore, it is possible that circulating TRAbs in Graves' patients both stimulate overproduction of thyroid hormones and increase orbital adipose tissue volume. Antibodies to the IGF-1 receptor appear to impact GO pathogenesis through recruitment and activation of T-cells and stimulation of hyaluronan production, processes that play key roles in the development of inflammation and increased orbital tissue swelling. Although originally thought to represent another causative agent, antibodies to extraocular muscles are now generally thought to be secondary to extraocular muscle inflammation and damage.

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Section: Novel Approaches To Therapymentioning

confidence: 81%

Pathogenesis of Graves' Ophthalmopathy: The Role of Autoantibodies

Khoo

Bahn

2007

Thyroid

139

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“…Even though several series have been reported (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), limitations preclude reliable conclusions regarding the use of RTX in LN. The largest series (20) included 21 LN, but the only details on renal outcome consisted of a "decrease of median urinary protein creatinine ratio from 446 to 190 mg/mmol at 6 mo, even though this was not statistically significant (P ϭ 0.06)." In the series with the longest follow-up (15) (24 mo), there was no information regarding kidney biopsy, and none of the patients had baseline renal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Rituximab in Severe Lupus Nephritis

Melander

Sallée

Trolliet

et al. 2009

Clinical Journal of the American Society of Nephrology

155

107

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Background and objectives: Standard treatment for lupus nephritis, including corticosteroids and cyclophosphamide, is efficient but is still associated with refractory or relapsing disease, or severe deleterious effects. Rituximab, a monoclonal chimeric anti-B cell antibody, is increasingly used in patients with lupus nephritis, but reported series were small and had a short follow-up.Design, setting, participants, & measurements: The authors analyzed clinical and histologic data of 20 patients who were treated with rituximab for lupus nephritis and followed up for at least 12 mo.Results: Nineteen women and one man received rituximab as induction treatment for an active class IV (15 cases) or class V (5 cases) lupus nephritis. Rituximab was given for lupus nephritis refractory to standard treatment (12 cases), for relapsing disease (6 cases), or as first-line treatment (2 cases). Three patients received cyclophosphamide concomitantly with rituximab. Ten received new injections of rituximab as maintenance therapy. Side effects included mainly five infections and four moderate neutropenias. After a median follow-up of 22 mo, complete or partial renal remission was obtained in 12 patients (60%). Lupus nephritis relapsed in one patient, who responded to a new course of rituximab. The achievement of B cell depletion 1 mo after rituximab, which negatively correlated with black ethnicity and hypoalbuminemia, was strongly associated with renal response. Rapidly progressive glomerulonephritis did not respond to rituximab. Conclusion: Rituximab is an interesting therapeutic option in relapsing or refractory lupus nephritis when early B cell depletion is obtained.

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“…And one randomized controlled study showed that MMF was more effective than intravenous cyclophosphamide in inducing remission of lupus nephritis and had a more favorable safety profile [7]. Another study summarized about rituximab treated SLE cases referred that 2 of 7 patients had lupus pleuritis and their clinical course showed improvement after B cell depletion [8]. For this reason, we administrated MMF and rituximab for control of SLE-associated pleurisy, but effect of these agents was limited.…”

Section: Discussionmentioning

confidence: 99%

Refractory Pleural Effusion in Systemic Lupus Erythematosus Treated by Pleurectomy

et al. 2017

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Pleural effusion is a common pulmonary manifestation of systemic lupus erythematosus (SLE) and often occurs as bilateral exudative pleural effusion. The condition usually responds quickly to corticosteroid therapy. However, massive pleural effusion refractory to immunosuppressive drugs has rarely been reported; thus, the proper therapeutic modality is largely decided on a case-by-case basis. In this case, we describe successful treatment with surgical pleurectomy for massive refractory pleural effusion in a patient with SLE. (J Rheum Dis 2017;24:43-47)

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Repeated B cell depletion in treatment of refractory systemic lupus erythematosus

Cited by 80 publications

References 11 publications

Pathogenesis of Graves' Ophthalmopathy: The Role of Autoantibodies

Pathogenesis of Graves' Ophthalmopathy: The Role of Autoantibodies

Rituximab in Severe Lupus Nephritis

Refractory Pleural Effusion in Systemic Lupus Erythematosus Treated by Pleurectomy

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