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B cell depletion therapy in systemic lupus erythematosus: Long term follow up and predictors of response
  1. Kristine P Ng (kristine.ng{at}ucl.ac.uk)
  1. University College London, United Kingdom
    1. Geraldine Cambridge (g.cambridge{at}ucl.ac.uk)
    1. University College London, United Kingdom
      1. Maria J Leandro (maria.leandro{at}ucl.ac.uk)
      1. University College London, United Kingdom
        1. Jonathan CW Edwards (jo.edwards{at}ucl.ac.uk)
        1. University College London, United Kingdom
          1. Michael Ehrenstein (m.ehrenstein{at}ucl.ac.uk)
          1. University College London, United Kingdom
            1. David A Isenberg (d.isenberg{at}ucl.ac.uk)
            1. University College London, United Kingdom

              Abstract

              Objectves:To describe the long term clinical outcome and safety profile of B cell depletion therapy (BCDT) in patients with SLE. We also determined if baseline parameters can predict likelihood of disease flare.

              Methods:Thirty two patients with refractory SLE were treated with BCDT using a combination protocol (rituximab and cyclophosphamide). Patients were assessed with the BILAG activity index and baseline serology was measured. Flare was defined as a new BILAG ‘A’ or two new subsequent ‘B’s in any organ or system.

              Results:Of the 32 patients, 12 have remained well after one cycle of BCDT (median follow up 39 months). BCDT was followed by a decrease of median global BILAG scores from 13 to 5 at 6 months (p = 0.006). Baseline anti-ENA was the only identified independent predictor of flare post BCDT (p = 0.034, odds ratio = 8, 95% CI 1.2 – 55) from multivariable analysis. Patients with low baseline serum C3 had a shorter time to flare post-BCDT (p = 0.008). Four serious adverse events were observed.

              Conclusion:Autoantibody profiling may help identify patients who will have a more sustained response. Although the long term safety profile of B cell depletion therapy is favourable, ongoing vigilance is recommended.

              • B cell depletion
              • long term follow up
              • predictors of flare
              • rituximab
              • systemic lupus erythematosus

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              • Dr M Leandro has received funding from Roche Pharmaceuticals and GlaxoSmithKline Research and Development Ltd

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