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AB0367 Lymphocyte b depletion and moderate to severe activity in patients with systemic lupus erythemathosus
  1. A. Acosta Pereira1,
  2. B. Magallares López1,
  3. A. Rodriguez de la Serna1
  1. 1Santa Creu I Sant Pau Hospital, Barcelona, Spain

Abstract

Background: INTRODUCTION Rituximab (RTX) induces a rapid and almost complete depletion of B cells in peripheral blood. It is used for patients with poor response to other therapies. The pharmacologic effect of RTX. appears to be independent of the CD20 function and is associated to complement mediated lyses, antibody cellular dependent cytotoxicity and the induction of apoptosis. (1-3)

Objectives

  1. Ponder efficacy defined by the improvement of the activity index of systemic Lupus Erythemathosus, (SLEDAI) and the progression of B lymphocyte depletion in patients treated with RTX.

  2. Correlate SLEDAI with the number of administered rituximab infusions.

  3. Define whether there is reduction of the dosage or suspension of the gluco-corticosteroids, by oral route, after the treatment with RTX.

Methods 13 patients that had received RTX. were analyzed retrospectively. Data reviewed before and after therapy, consisted of : anti-DNA antibody, (anti-DNA), SLEDAI and prednisone dosage. B cell depletion was measured after treatment, (defined as B-lymphocyte <1%), and the average number of RTX infusions during the analyzed years, was also evaluated.

Results 13 patients (76,92% female and 23,07% male), with a mean age of 44 years with the diagnosis of systemic lupus Erythematosus in the prior 1,5 to 35 years (median 14,5 years of disease progression) that had arthritis30,76%, lupus nephritis 23,07%, recurrent pericarditis 15,38%, hematological features 15,38%, shrunken lung 7,69%. were studied. All patients had a reduction of anti-DNA and SLEDAI was statistically significant. (P= <0,003, Paired T test). Anti-DNA diminution showed a variability that decreased it s potency to be statistically significant (P= 0,172 : T Test). All patients experimented a significant reduction of the dosage of prednisone (mean pretreatment dosage, 10 mg versus mean dosage after treatment, 5 mg) (P= 0,004: Wilcoxon test). Even though all patient improve by SLEDAI, this was more so in the patients that received a larger number of infusions, establishing that the diminution of SLEDAI was depended of the number of infusions received by the patients, and this diminution was statistically significant. (P=0,003 :ANOVA)

There was no correlation between the the depletion of B lymphocites and the Sledai value. (P= 0,532 : ANOVA)

Conclusions RTX is a therapeutic option that is efficient in patients with moderate to severe SLE that are refractory to other therapies.

The efficacy measured by SLEDAI correlates with the number of received infusions and is not related with with the B-lymphocyte depletion. Treatment with rituximab permits to decrease significantly the dose of Prednisone.

  1. Jennifer H. Anolik, Jennifer Barnard, Amedeo Cappione, Aimee E. Pugh-Bernard, Raymond E. Felgar, R. John Looney, and Inaki Sanz. Rituximab Improves Peripheral B Cell Abnormalities in Human Systemic Lupus Erythematosus arthritis rheum 2004; 56: 3580–90.

  2. J. Silverman. Anti-CD20 Therapy in Systemic Lupus Erythematosus: A Step Closer to the Clinic Gregg. Arthritis rheum 2005; 57: 371–7

  3. Bang SY, Lee CK, Kang YM, Kim HA, Suh CH, Chung WT, Park YB, Choe JY, Kim TJ, Park YW, Yoo DH, Bae SC, Lee HS. Multicenter retrospective analysis of the effectiveness and safety of rituximab in korean patients with refractory systemic lupus erythematosus. Autoimmune Dis. 2012

Disclosure of Interest None Declared

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