The efficacy of repeated treatment with B-cell depletion therapy in systemic lupus erythematosus: an evaluation

Turner‐Stokes, Tabitha; Lu, Tim; Ehrenstein, Michael R.; Giles, Ian; Rahman, Anisur; Isenberg, David

doi:10.1093/rheumatology/ker018

Cited by 79 publications

(36 citation statements)

References 17 publications

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“…Seventy-six of these articles had to be further excluded, as these provided incomplete data or had irrelevant objectives and were unsuitable for meta-analysis. Remaining 31 articles were included for meta-analysis (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Flowchart of the studies evaluated is represented in Figure 1.…”

Section: Search Resultsmentioning

confidence: 99%

Outcomes of rituximab therapy in refractory lupus: A meta-analysis

Alshaiki¹,

Obaid²,

Almuallim³

et al. 2018

Eur J Rheumatol

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Section: Search Resultsmentioning

confidence: 99%

Outcomes of rituximab therapy in refractory lupus: A meta-analysis

Alshaiki¹,

Obaid²,

Almuallim³

et al. 2018

Eur J Rheumatol

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“…Percentages of patients in each group were similar (7 of 12 [58%] in the low IgM group and 22 of 45 [49%] in the normal IgM group). Detailed patient demographics and clinical responses of this cohort of 57 patients have been previously described 31, 32, 33. The median age at the time of the first rituximab treatment cycle was 34 years (range 17–74 years).…”

Section: Resultsmentioning

confidence: 99%

Pragmatic Treatment of Patients With Systemic Lupus Erythematosus With Rituximab: Long‐Term Effects on Serum Immunoglobulins

Reddy

Martinez

Isenberg

et al. 2017

Arthritis Care & Research

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ObjectiveB cell–depletion therapy based on rituximab is a therapeutic option for refractory disease in patients with systemic lupus erythematosus (SLE). The aim of this observational study was to document long‐term effects on B cell function by following serum immunoglobulin levels in patients with SLE treated with rituximab in routine clinical practice.MethodsWe included 57 consecutive patients with SLE treated with rituximab and concomitant/sequential immunosuppressants and measured serum total IgG, IgM, and IgA and IgG anti‐dsDNA antibodies, over a median of 48 months most recent followup. Flow cytometry was used prospectively to assess B cell phenotypes in 17 of 57 patients.ResultsTwelve patients (21%) had persistent IgM hypogammaglobulinemia (<0.4 gm/liter), and 4 of 57 (5%) had low IgG (<7 gm/liter) at the most recent followup (range 12–144 months). This was not associated with serious adverse events or high anti–double‐stranded DNA (anti‐dsDNA) antibodies (>1,000 IU/ml; normal <50 IU/ml). Factors predictive of low serum IgM included baseline serum IgM ≤0.8 gm/liter (receiver operator curve analysis) and subsequent therapy with mycophenolate mofetil (MMF; odds ratio 6.8, compared with other immunosuppressants). In patients maintaining normal IgM levels (9 of 17), the frequency of circulating IgD+CD27+ B cells was significantly higher (P = 0.05). At 12 months after rituximab, 7 of 30 SLE patients with baseline anti‐dsDNA ≤1,000 IU/ml had lost seropositivity.ConclusionLower baseline serum IgM levels and sequential therapy with MMF were predictive of IgM hypogammaglobulinemia after rituximab in SLE, but this was not associated with higher levels of anti‐dsDNA antibodies or an increased risk of infections. This provides useful directions for clinicians regarding rituximab and sequential immunosuppressive treatment for patients with SLE.

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“…Tables 1 and 2 show a summary of included studies. We found 2 RCTs (Furie et al, 2009;Merrill et al, 2011) and 19 observational studies (Leandro et al, 2002;Leandro et al, 2005;Vigna-Perez et al, 2006;Gunnarsson et al, 2007;Tokunaga et al, 2007;Sutter et al, 2008;Tamimoto et al, 2008;Melander et al, 2009;Pepper et al, 2009;Catapano et al, 2010;Lateef et al, 2010;Ramos-Casals et al, 2010;Terrier et al, 2010;Pinto et al, 2011;Roccatello, 2011;Tony et al, 2011;Turner-Stokes et al, 2011;Vital et al, 2011;Arce-Salinas et al, 2012).…”

Section: Resultsmentioning

confidence: 78%

“…Although studies 11 (Turner-Stokes et al, 2011), 12 (Roccatello et al, 2011), and 14 (Catapano et al, 2010) also reported on BILAG, they were excluded due to missing data. The homogeneity χ 2 test value of BILAG data from studies 1, 2, 9, and 10 was 3.95 (P=0.27 (>0.05)); therefore, the 4 studies were considered homogeneous.…”

Section: Effect On Bilagmentioning

confidence: 99%

Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

Lan

Han

Chen

2012

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To review the efficacy and safety of rituximab therapy for systemic lupus erythematosus (SLE). Methods: We searched for randomized controlled trails and observational studies that evaluated the effect of rituximab based on the systemic lupus erythematosus disease activity index (SLEDAI), British Isles lupus assessment group index (BILAG), urine protein levels, and the prednisolone dose, and had adequate data to calculate the mean, standard deviation (SD), and 95% confidence intervals, and to systematically review and meta-analyze observational studies with fixed effects model or random effects model. Results: We included 2 randomized controlled studies and 19 observational clinical studies. We summarized the data from the 19 observational studies, analyzed the heterogeneity of the literature, and then used fixed effect model or random effect model for statistical analysis. The SLEDAI, BILAG, and urine protein levels and the prednisolone dosage were decreased after rituximab treatment, and the decreases in the BILAG, urine protein levels, and the prednisolone dose were found to be significant (P<0.05), when compared with baseline level. Rituximab's adverse effects generally could be controlled with an effective dosing regimen. Conclusions: Although there are still controversies about rituximab's treatment on SLE, but our study had showed that rituximab had favorable effects on refractory lupus. The long-term efficacy and safety of rituximab require further study.

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The efficacy of repeated treatment with B-cell depletion therapy in systemic lupus erythematosus: an evaluation

Abstract: Repeated cycles of BCDT with rituximab are effective in treating refractory SLE and has a favourable safety profile. Retreatment may produce a more sustained clinical response.

Cited by 79 publications

References 17 publications

Outcomes of rituximab therapy in refractory lupus: A meta-analysis

Outcomes of rituximab therapy in refractory lupus: A meta-analysis

Pragmatic Treatment of Patients With Systemic Lupus Erythematosus With Rituximab: Long‐Term Effects on Serum Immunoglobulins

Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

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