Treatment of refractory antibody mediated autoimmune disorders with an anti-CD20 monoclonal antibody (rituximab)

Arzoo, Karo K.; Sadeghi, S; Liebman, Howard A.

doi:10.1136/ard.61.10.922

Cited by 131 publications

(71 citation statements)

References 13 publications

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“…This multicenter, retrospective study including a large patients' series further supports and expands the results of previous reports showing the usefulness of rituximab in active MCs [9][10][11][12][24][25][26][27][28][29][30][31]. The positive effects of this treatment were particularly evident for the most frequent disease manifestations such cutaneous vasculitic lesions, i.e.…”

Section: Discussionsupporting

confidence: 68%

“…Review papers were excluded. A total of 39 manuscripts that reported on at least one case of cryoglobulinemic vasculitis treated with rituximab were included in the present analysis [9][10][11][12][24][25][26][27][28][29][30][31]. Three manuscripts were excluded because they included patients that had already been described in other publications [9,11,37].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…These therapies may be responsible for serious, seldom life-threatening complications; therefore, the management of patients with MCs is often particularly difficult [5,6]. Since 1999 anecdotal observations followed by two pilot studies showed the efficacy and safety of anti-CD20 monoclonal antibody (rituximab) treatment in patients with cryoglobulinemic vasculitis, often resistant or intolerant to other therapies [9][10][11][12]. The safety and efficacy of this drug have been reported in various vasculitides and other systemic autoimmune diseases [13][14][15][16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Treatment with rituximab in patients with mixed cryoglobulinemia syndrome: Results of multicenter cohort study and review of the literature

Ferri

Cacoub

Mazzaro³

et al. 2011

Autoimmunity Reviews

164

109

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Section: Discussionsupporting

confidence: 68%

Section: Review Of the Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment with rituximab in patients with mixed cryoglobulinemia syndrome: Results of multicenter cohort study and review of the literature

Ferri

Cacoub

Mazzaro³

et al. 2011

Autoimmunity Reviews

164

109

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“…Rituximab, a chimeric anti-CD20 monoclonal antibody, causes a rapid depletion of B cells [9]. Although rituximab was originally introduced for the treatment of malignant lymphomas [10,11], several recent studies have shown that rituximab may also be effective in the treatment of ITP and other autoimmune diseases [12,19,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. The current results of all published case reports and clinical trials using rituximab in the treatment of immune thrombocytopenias have most recently been reported showing an overall response rate of about 50% [34].…”

Section: Introductionmentioning

confidence: 99%

Rituximab chimeric anti‐CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura

et al. 2005

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Idiopathic thrombocytopenic purpura is an autoimmune disease which involves opsonization of platelets by autoantibodies directed against different surface glycoproteins, leading to their premature destruction by the reticuloendothelial system. Management of patients with refractory ITP is difficult. Recent studies have shown that rituximab, a chimeric anti‐CD20 monoclonal antibody, is useful in the treatment of these patients, with overall response rates of about 50%. Most published reports have included a small number patients including case reports. The present study reports the results of a retrospective Danish multicenter study of rituximab in the treatment of adult patients with refractory ITP. Thirty‐five patients (median age 52 years, range 17–82 years, 17 males) were included. One patient had immune thrombocytopenia and neutropenia. All patients had received prednisolone (Pred). Next to Pred, 25 patients had been treated with high‐dose IgG, and in 16 patients a splenectomy had been performed. Sixteen patients had been treated with azathioprine. Other treatments included, e.g., cyclosporine, danazol, cyclophosphamide, vincristine, interferon, and dexamethasone. The patients were treated with a dose regimen of 375 mg/m2 i.v. approximately once weekly for 4 consecutive weeks. Six patients received a fixed dose of 500 mg disregarding their weight supplemented by 100 mg of methylprednisone i.v. or 50–100 mg of Pred given as premedication together with an antihistamine just before infusion of rituximab. The large majority of patients also received Pred and, in some cases, other concomitant immunosuppressive treatment during part of their rituximab treatment. A complete response (CR) was defined as a rise in the platelet count > 100 × 109/L, a partial response (PR) as a rise in the platelet count > 50 × 109/L, and a minor response (MR) as a rise in the platelet count < 50 × 109/L. No response (NR) was defined as no increase in the platelet count. Because 4 patients were treated twice, a total of 39 outcomes of rituximab treatment were evaluated. Rituximab proved to be effective in 17 of 39 treatments [overall response 44% with 7 CR (18%) (1 patient showed a CR twice), 6 PR (15%), and 4 MR (10%)]. In 9/13 cases of CR or PR, the response (platelet level > 50 × 109/L) was prompt, 1–2 weeks after the first infusion. The remaining patients responded 3–8 weeks later. Patients with CR and PR have been in remission for a median of 47 weeks. In general the side effects were few. In 2 cases, the treatment was stopped because of side effects either during or after the first infusion. Two fatal outcomes were recorded. A 71‐year‐old female with severe lung disease died 6 days after the first infusion of respiratory failure. The other patient, a 73‐year‐old man also with severe chronic obstructive lung disease, died of pneumonia approximately 13 weeks following the last rituximab treatment. It is concluded that rituximab may be a useful alternative therapy in patients with severe and symptomatic ITP refractory to conventional treatment. Am. J. Hematol. 78:275–280, 2005. © 2005 Wiley‐Liss, Inc.

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“…By depleting B cells, rituximab has the potential to reduce the clonal B cell expansion and the development of plasma cells, thereby limiting cryoglobulin production. Some authors have shown promising results with rituximab in refractory CV, but the most patients were HCV positive and the amount of experience is still limited (9)(10)(11)(12)(13) . In our study, the patients who were refractory to conventional immunosuppressive agents responded well to rituximab.…”

Section: Discussionmentioning

confidence: 99%

Non-hepatitis C virus crioglobulinemic vasculitis: a case series of nine patients

Cruz¹,

Melo²,

Filho³

et al. 2006

Rev. Bras. Reumatol.

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Introdução: vasculite crioglobulinêmica (Vc) é uma vasculite sistêmica secundária à deposição de imunocomplexos circulantes em vasos saguíneos de pequeno calibre. Na maior parte dos pacientes está associada à infecção pelo vírus da hepatite C (VHC), entretanto pode ser observada em outras doenças e em pacientes sem outras condições clínicas -"crioglobulinemia essencial". Objetivo: relatar uma série de pacientes com Vc sem infecção pelo HCV. Pacientes e Métodos: foi realizada uma revisão retrospectiva dos prontuários de pacientes com Vc sem infecção pelo HCV em acompanhamento por membros do Grupo Mineiro de Estudo das Vasculites (MGVSG). Dados epidemiológicos, clínicos, laboratoriais, tratamento e seguimento são relatados. Resultados: nove pacientes, dois homens e sete mulheres, com idade de 55,3 + 17 anos foram incluídos no estudo. Em três pacientes, Vc foi atribuída a doenças difusas do tecido conjuntivo e em um paciente à gamopatia monoclonal de significado inespecífico (MGUS). Cinco pacientes apresentaram crioglobulinemia essencial. Quatro pacientes apresentaram infiltração linfóide em biópsia de medula óssea, mas nenhum desenvolveu linfoma propriamente dito. Oito pacientes (89%) apresentaram vasculite cutânea; quatro (44%) apresentaram glomerulonefrite (GN) e seis (67%) apresentaram neuropatia. Quanto ao tratamento, seis pacientes responderam à combinação de corticóide e imunossupressores. Três pacientes mostraram-se refratários a esta abordagem e receberam rituximabe. Após seguimento de 19,3 + 14 meses, cinco pacientes (56%) estão em remissão parcial e quatro (44%) em remissão completa. Conclusão: crioglobulinemia não-associada ao VHC pode se apresentar como uma vasculite sistêmica. Vc não deve ser entendida como uma doença inflamatória simples, já que a maior parte dos pacientes apresenta evidência de uma doença linfoproliferativa. O tratamento usual inclui corticóide e imunossupressores. Pacientes refratários podem se beneficiar com rituximabe.Palavras-chave: vasculite sistêmica, crioglobulinemia, vasculite crioglobulinêmica.

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Treatment of refractory antibody mediated autoimmune disorders with an anti-CD20 monoclonal antibody (rituximab)

Cited by 131 publications

References 13 publications

Treatment with rituximab in patients with mixed cryoglobulinemia syndrome: Results of multicenter cohort study and review of the literature

Treatment with rituximab in patients with mixed cryoglobulinemia syndrome: Results of multicenter cohort study and review of the literature

Rituximab chimeric anti‐CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura

Non-hepatitis C virus crioglobulinemic vasculitis: a case series of nine patients

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