Rituximab therapy in refractory neuropsychiatric lupus: current clinical evidence
- PMID: 21875742
- DOI: 10.1016/j.semarthrit.2011.06.004
Rituximab therapy in refractory neuropsychiatric lupus: current clinical evidence
Abstract
Objective: To review and summarize published information on the effectiveness and safety of rituximab (RTX) in adult patients with refractory neuropsychiatric systemic lupus erythematosus (NPSLE).
Methods: We describe a patient with persistently active NPSLE, despite conventional therapy, who responded dramatically to RTX. Current evidence on the therapeutic use of RTX in this complex situation is also analyzed through a systematic review of the English-language literature, based on a PubMed search.
Results: Available data on the use of RTX in refractory NPSLE come from a large number of case reports and some open-label studies. Including our case, 35 patients have been well documented. A complete or partial therapeutic response was achieved in 85% of patients after 1 cycle of treatment. A positive correlation between serological markers of disease activity and clinical outcome has also been demonstrated in some of these patients. Clinical improvement was accompanied by a significant reduction in the daily dose of oral corticosteroids. Relapse after RTX treatment was noted in 45% of cases (median 9.5 months; range, 4-33 months). Infections were observed in 29% of patients.
Conclusion: Evidence for the effectiveness of RTX as induction therapy in NPSLE is based solely on several case reports and noncontrolled trials. Although it is not yet possible to make definite recommendations, the global analysis of these cases supports the off-label use of RTX in cases of severe refractory NPSLE.
Copyright © 2011 Elsevier Inc. All rights reserved.
Similar articles
-
Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system.Ann Rheum Dis. 2007 Apr;66(4):470-5. doi: 10.1136/ard.2006.057885. Epub 2006 Nov 15. Ann Rheum Dis. 2007. PMID: 17107983 Free PMC article. Clinical Trial.
-
Safety and efficacy of rituximab in systemic lupus erythematosus: results from 136 patients from the French AutoImmunity and Rituximab registry.Arthritis Rheum. 2010 Aug;62(8):2458-66. doi: 10.1002/art.27541. Arthritis Rheum. 2010. PMID: 20506527
-
Rituximab induces a rapid and sustained remission in Colombian patients with severe and refractory systemic lupus erythematosus.Lupus. 2011 Oct;20(11):1219-26. doi: 10.1177/0961203311409273. Epub 2011 Jul 22. Lupus. 2011. PMID: 21784778
-
Biological agents in the management of Felty's syndrome: a systematic review.Semin Arthritis Rheum. 2012 Apr;41(5):658-68. doi: 10.1016/j.semarthrit.2011.08.008. Epub 2011 Nov 25. Semin Arthritis Rheum. 2012. PMID: 22119104 Review.
-
Treatment of antineutrophil cytoplasmic antibody-associated vasculitis with rituximab.Curr Opin Rheumatol. 2012 Jan;24(1):15-23. doi: 10.1097/BOR.0b013e32834d5730. Curr Opin Rheumatol. 2012. PMID: 22089095 Review.
Cited by
-
Predictive Factors of the Use of Rituximab and Belimumab in Spanish Lupus Patients.Medicina (Kaunas). 2023 Jul 25;59(8):1362. doi: 10.3390/medicina59081362. Medicina (Kaunas). 2023. PMID: 37629652 Free PMC article.
-
Current treatment of systemic lupus erythematosus: a clinician's perspective.Rheumatol Int. 2023 Aug;43(8):1395-1407. doi: 10.1007/s00296-023-05306-5. Epub 2023 May 12. Rheumatol Int. 2023. PMID: 37171669 Free PMC article. Review.
-
Biological therapy in systemic lupus erythematosus, antiphospholipid syndrome, and Sjögren's syndrome: evidence- and practice-based guidance.Front Immunol. 2023 Apr 17;14:1117699. doi: 10.3389/fimmu.2023.1117699. eCollection 2023. Front Immunol. 2023. PMID: 37138867 Free PMC article. Review.
-
Bortezomib is efficacious in the treatment of severe childhood-onset neuropsychiatric systemic lupus erythematosus with psychosis: a case series and mini-review of B-cell immunomodulation in antibody-mediated diseases.Clin Rheumatol. 2023 Jul;42(7):1965-1979. doi: 10.1007/s10067-023-06559-y. Epub 2023 Mar 27. Clin Rheumatol. 2023. PMID: 36971919 Review.
-
Progress in the Pathogenesis and Treatment of Neuropsychiatric Systemic Lupus Erythematosus.J Clin Med. 2022 Aug 24;11(17):4955. doi: 10.3390/jcm11174955. J Clin Med. 2022. PMID: 36078885 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical