Background Pulmonary fibrosis is one of the gravest manifestations of Systemic Sclerosis (SSc) and conventional DMARDs therapy has not shown any particular positive effect.
Objectives Our goal was to see whether the elimination pf B - lymphocytes through use of anti – CD20 Mab, Rituximab (RTX) would offer to the improvement of the pulmonary function of SSc patients.
Methods We studied 23 SSc patients with pulmonary fibrosis, who received treatment with RTX (n=12) or DMARDs treatment (n=11) for 1 to 3 years (1,9 years). Conventional therapy included azathioprine (n=4), mycophenalate (n=6) and methotrexate (n=2). RTX – treated patients were recorded with FVC improvement in the first year of treatment (FVC 81,3 +/- 12,6 vs FVC 87,4 +/- 11,3 out on the onset of the study and at the first year respectively, p=0,02) when on the other hand DMARDs treated patients didn't show any FVC improvement at all.
Results All RTX – treated patients did not present any lung HRCT deterioration imaging, in contrast to DMARDs – treated patients who were also submitted to lung HRCT each year of the study, all showing signs of CT imaging deterioration. Similar findings, as far as FVC was concerned, were recorded at the 3rd year of the study (RTX patients, n=6 and DMARDs patients, n=11). 3rd year RTX FVC was 92,6 +/-13,2 vs 80,7 +/-11,8 at the onset of the study, p=0,04 when DMARDs treated patients were all presented with worst 3rd year FVC compared to their primary FVC, p<0,01.
Conclusions Our small cohort of SSc patients with pulmonary fibrosis shows that it is possible that rituximab may be proven helpful to at least prevent the deterioration of the interstitial pulmonary fibrosis of Systemic Sclerosis. The pathophysiology of this particular fibrosis and the possible molecular role of B-lymphocytes in the inversion of this procedure need yet to be furtherly explored.
Disclosure of Interest None declared
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