Long‐term comparison of rituximab treatment for refractory systemic lupus erythematosus and vasculitis: Remission, relapse, and re‐treatment

作者：Kenneth G. C. Smith, Rachel Jones, Stella Burns, David Jayne · 发表于：Arthritis & Rheumatism · 年份：2006 · DOI：10.1002/art.22046 · 被引用次数：400 · 研究领域：Systemic Lupus Erythematosus Research、Vasculitis and related conditions、Systemic Sclerosis and Related Diseases

OBJECTIVE: Current treatments for systemic lupus erythematosus (SLE) and vasculitis contribute to mortality and incapacity and are only partially effective; thus, newer therapies are clearly needed. Depletion of B cells has led to disease control in patients with autoimmune disorders. We sought to assess the long-term efficacy and safety of a B cell-depleting therapy in patients with SLE and patients with vasculitis. METHODS: In a prospective study with a median followup of 24 months, 11 patients with active or refractory SLE and 11 patients with active or refractory antineutrophil cytoplasmic antibody-associated vasculitis (AAV) received a course of therapy with rituximab (an anti-CD20 monoclonal antibody) along with a single dose of intravenous cyclophosphamide. RESULTS: Remission followed rapid B cell depletion, with response rates of 100% among the 11 patients with SLE (6 patients had a complete response, and 5 patients had a partial response) and 91% among the 11 patients with AAV (9 patients had a complete response, and 1 patient had partial remission). A renal response occurred in all 6 patients with lupus nephritis. Clinical improvement was accompanied by significant reductions in the daily dose of prednisolone. Relapse occurred in 64% of the patients with SLE and in 60% of those with AAV. B cell return preceded relapse in the majority of patients, and further treatment with rituximab proved effective. IgG and IgM levels were maintained in the normal range. The incide...