Rituximab for Remission Induction and Maintenance in Refractory Systemic Lupus Erythematosus

Bonilla-Abadía, Fabio; Coronel-Restrepo, Nicolás; Tobón, Gabriel J.; Echeverri, Alex; Muñoz-Buitrón, Evelyn; Castro, Andrés; Bejarano, Mercedes Andrade; Cañas, Carlos A.

doi:10.1155/2014/731806

Cited by 15 publications

(9 citation statements)

References 19 publications

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“…The present report describes the cases of four women with SLE who presented manifestations related to the disease that include variable mucocutaneous, musculoskeletal, renal, haematological, neurological, and immunological involvement associated with the presence of autoantibodies (ANAs, anti-DNA antibodies, and anti-Sm antibodies) and complement consumption (C3 and C4), which were managed with conventional treatments such as glucocorticoids, azathioprine, intravenous cyclophosphamide, and mycophenolate mofetil with partial clinical response; therefore, it was necessary to add rituximab to their treatment plan, as described [ 22 ]. With this medication, three of these patients showed initial clinical and paraclinical improvement; therefore, maintenance therapy continued in the form of cycles approximately every nine months.…”

Section: Discussionmentioning

confidence: 99%

Very Severe and Refractory Noninfectious Cystitis in Patients with Systemic Lupus Erythematosus: Potential Role of Rituximab Therapy

Ocampo-Piraquive

Mondragón-Lenis

Rios

et al. 2021

Case Reports in Rheumatology

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Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with various clinical manifestations, including, rarely, a form of interstitial cystitis (lupus cystitis, LC). LC can be asymptomatic and usually has discrete symptoms that improve with conventional therapies available for SLE and/or typical interstitial cystitis. A very severe and refractory form is rarely described. In this study, we present four patients with SLE and a very severe form of noninfectious cystitis refractory to the different forms of treatment described. The clinical descriptions of the cases, demographic factors, manifestations associated with SLE, and clinical and paraclinical manifestations related to cystitis, treatments, and outcomes are provided. A proposal for the pathogenesis of this condition is based on the common findings of these patients, including the fact that three were in SLE remission and all four receiving rituximab as induction and/or maintenance therapy.

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Section: Discussionmentioning

confidence: 99%

Very Severe and Refractory Noninfectious Cystitis in Patients with Systemic Lupus Erythematosus: Potential Role of Rituximab Therapy

Ocampo-Piraquive

Mondragón-Lenis

Rios

et al. 2021

Case Reports in Rheumatology

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“…La presenza di quest'ultima classe istologica, di un'insufficienza renale o di una sindrome nefrosica si associa a una minore percentuale di risposta (20). Il RTX è stato impiegato secondo schemi molto eterogenei sia come monoterapia che in combinazione con gli immunodepressori tradizionali, con risultati spesso positivi, evidenziati da studi di Registri e case-series di varia numerosità (20)(21)(22). Tuttavia, l'unico studio randomizzato controllato nel quale il RTX è stato confrontato con una terapia di induzione con micofenolato mofetile (MMF) e steroide nella nefrite lupica proliferativa di classe III-IV (studio LUNAR) non ha evidenziato differenze significative (remissione completa o parziale a 1 anno 57% vs 46%) (23).…”

Section: Glomerulonefrite Lupicaunclassified

The role of rituximab in the therapy of secondary glomerulonephritis

Quaglia

Musetti

Stratta

2015

Giornale di Tecniche Nefrologiche e Dialitiche

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Rituximab (RTX), a B-lymphocytes depleting monoclonal antibody, deeply changed the therapeutic landscape of secondary glomerulonephritis in the past decade. RTX has proved to be as effective as cyclophosphamide in inducing remission in ANCA-associated vasculitis and better than azathioprine as maintenance therapy in three different RCT. Treatment's duration and modality, however, remain debated. RTX has been widely used in resistant or relapsing proliferative lupus nephritis (LN), with positive results reported by retrospective studies; however, when employed as an “add-on” induction therapy in a RCT, it did not show a definite additive effect to standard therapy with mycophenolate mofetil and steroid in moderate forms of LN. In prospect, it remains a promising tool both as second-line therapy for resistant forms and as a “steroid-sparing” agent to strengthen induction and to allow reduced or minimal maintenance therapy. RTX is effective in the treatment of HCV-related cryoglobulinemic vasculitis, including glomerulonephritis. Monotherapy appears more effective than traditional cytostatic drugs in anti-viral drugs resistant forms. Association of RTX with antiviral therapy (pegINFα and ribavirin) produces a more rapid and effective immunological response with a similar virological one. Direct antiviral agents are beginning to be employed in association with traditional ones and RTX with promising results. RTX has been also anecdotally employed in fibrillary glomerulonephritis and in “monoclonal immunoglobulin deposits-related glomerulopathy” (mIgGN) secondary to non-Hodgkin lymphomas, either alone or within the setting of a hematological chemotherapy. Although many aspects need to be clarified, the role of RTX in the treatment of secondary glomerulonephritis has become increasingly important due to a favorable risk/benefit profile.

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“…It was, as the Beatles so nearly put it, approximately twenty years ago today the first attempt to treat patients with active systemic lupus erythematosus with B-cell depletion was undertaken at the Centre for Rheumatology, University College Hospital. We reported the first 6 patients that we treated with a six-month follow-up in 2002 1 and numerous openlabel studies [2][3][4][5][6][7][8] and some large-scale clinical trials have been published since. [9][10][11] Rituximab is a monoclonal antibody directed against the B-cell specific antigen CD20 which acts as an efficient depleter of B-cells in the peripheral blood.…”

Section: Introductionmentioning

confidence: 99%

Rituximab – The first twenty years

Leandro

Isenberg

2021

Lupus

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It is now two decades since Rituximab was first used in the treatment of patients with systemic lupus erythematosus. There have been many challenges but in spite of failing to meet its primary endpoints in two clinical trials it is widely used for many aspects of lupus, its side-effects and the possibility that combining it with Benlysta may be of value. We also consider the proposal that it may provide a useful initial therapy. In this review, we consider the place of Rituximab in the treatment of lupus and anticipate how developments in fully-humanized anti-CD20 monoclonals may well extend the “therapeutic life” of B-cell depletion as a viable treatment option.

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Rituximab for Remission Induction and Maintenance in Refractory Systemic Lupus Erythematosus

Cited by 15 publications

References 19 publications

Very Severe and Refractory Noninfectious Cystitis in Patients with Systemic Lupus Erythematosus: Potential Role of Rituximab Therapy

Very Severe and Refractory Noninfectious Cystitis in Patients with Systemic Lupus Erythematosus: Potential Role of Rituximab Therapy

The role of rituximab in the therapy of secondary glomerulonephritis

Rituximab – The first twenty years

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