RT Journal Article
SR Electronic
T1 Variability in the biological response to anti-CD20 B cell depletion in systemic lupus erythaematosus
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1724
OP 1731
DO 10.1136/ard.2007.083162
VO 67
IS 12
A1 D Albert
A1 J Dunham
A1 S Khan
A1 J Stansberry
A1 S Kolasinski
A1 D Tsai
A1 S Pullman-Mooar
A1 F Barnack
A1 C Striebich
A1 R J Looney
A1 E T Luning Prak
A1 R Kimberly
A1 Y Zhang
A1 R Eisenberg
YR 2008
UL http://ard.bmj.com/content/67/12/1724.abstract
AB Objective: To study the effects in systemic lupus erythaematosus (SLE) of B cell directed therapy with rituximab, a chimeric monoclonal antibody directed at CD20+ B cells, without concomitant immunosuppressive therapy in mild to moderate SLE.Methods: Patients (n = 24) with active SLE and failure of ⩾1 immunosuppressive were recruited from three university centres into this phase I/II prospective open-label study. Patients were followed for 1 year to assess safety, efficacy and biological effects.Results: In total, 18 of the patients scheduled to receive the full lymphoma dose of rituximab were evaluable for B cell levels in peripheral blood. Of these, 17 had effective CD19+ B cell depletion (<5 cells/μl). However, six of the depleted patients showed B cell return before 24 weeks. A total of 70% of patients improved by week 55, as defined by an SLE Disease Activity Index (SLEDAI) score improvement of ⩾2 units from baseline. The degree of CD19+ B cell depletion was correlated with SLEDAI improvement at week 15 (r = 0.84). In general, rituximab infusions were well tolerated. Approximately a third of the patients developed human anti-chimeric antibody (HACA) titres, which correlated with poor B cell depletion. Most patients (9 of 14) did not respond to immunisations with Pneumovax and tetanus toxoid.Conclusions: Rituximab is a promising new therapy for SLE. The variability of responses in patients with SLE may be related to HACA formation. The failure to respond to immunisations is surprising, in view of the apparently low risk of infections. Better biological markers are necessary to follow these patients during treatment.