Use of rituximab as a treatment for systemic lupus erythematosus: retrospective review

Abstract

Objective:To report the experience in three Brazilian institutions with the use of rituximab in patients with different clinical forms of lupus erythematosus systemic in activity.Methods:The study consisted of a sample of 17 patients with LES, who were already being treated, but that at some stage of the disease showed refractory symptoms. The patients were subdivided into groups according to the clinical manifestation, and the responses for the use of rituximab were rated as complete, partial or no response. Data were collected through a spreadsheet, and used specific parameters for each group. The treatment was carried on by using therapeutic dose of 1g, and repeating the infusion within an interval of 15 days.Results:The clinical responses to rituximab of the group only hematological and of the group only osteoarticular were complete in all cases. In the renal group there was a clinical complete response, two partial and one absent. In the renal and hematological group complete response, there was one death and a missing response. The pulmonary group presented a complete response and two partial.Conclusion:The present study demonstrated that rituximab can bring benefits to patients with lupus erythematosus systemic, with good tolerability and mild side effects; it presented, however, variable response according to the system affected.

Anticuerpos monoclonales y el tratamiento del lupus eritematoso sistémico

“…La mortalidad y la morbilidad se relacionan con daño severo en los órganos, infecciones a causa de la inmunosupresión y eventos cardiovasculares secundarios [2]. Un estudio por parte del Centro para el Control de Enfermedades (CDC, por sus siglas en inglés) describió un aumento importante en el número anual de muertes, que pasó de 39 a 52 por cada 10 millones de habitantes y totalizó 22 861 muertes en el período entre 1979 y 1998.…”

“…A pesar de que se conoce esta actividad de las citoquinas, aún no se sabe completamente cómo es la participación de las células B en la fisiopatología de esta enfermedad [2].…”

“…El lupus eritematoso sistémico (LES) es una enfermedad autoinmune crónica que implica la producción de ciertos anticuerpos en todo el cuerpo y la consecuente inflamación de tejidos conjuntivos [1]. Es bastante progresiva, y mortal cuando no se lleva a cabo el tratamiento adecuado [2]. Además, posee una prevalencia por encima de los 150 por cada 100 000 habitantes por año en Estados Unidos [3], y en países de Europa, de entre 28 y 71 por cada 100 000 habitantes por año [4].…”

“…Los anticuerpos producidos en este trastorno autoinmune tienen la característica de que actúan en contra de componentes nucleares, particularmente anticuerpos contra ADN de doble cadena. Esto conduce a la creación de complejos inmunes circulantes [2]. Dichos complejos se depositan en órganos y producen daño en sus tejidos [8].…”

Lúpus Eritematoso Sistêmico: relação entre os diferentes tratamentos e evolução clínica

“…In addition to NETs, which are proposed as important autoantigens for the development of ANAs, patients with SLE have hyperactivity characteristics of B lymphocytes, including the typical increase in circulating plasmocytes. Experimentally, it was observed that if these cells were removed from mouse "lupus models" by genetic manipulation or antibody therapy, the chain of immune reactions would be largely suppressed, including T-cells induced abnormalities 2,3 .…”