Longterm clinical and immunological effects of anti-CD20 treatment in patients with refractory systemic lupus erythematosus.

• OBJECTIVE: To retrospectively evaluate longterm clinical and immunological effects of anti-CD20 treatment in patients with systemic lupus erythematosus (SLE) with active nephritis or autoantibody-mediated cytopenias refractory to conventional immunosuppressive treatment. METHODS: Anti-CD20 treatment (rituximab) was added to the ongoing immunosuppressive treatment in 31 SLE patients with active nephritis (n = 17), thrombocytopenia (n = 10), and hemolytic anemia (n = 4) refractory to conventional therapy. Disease activity was evaluated by the SLE Disease Activity Index. The median followup time after anti-CD20 treatment was 22 months (range 1-61 mo). RESULTS: Complete B cell depletion was obtained in all patients. In 11 of the 17 lupus nephritis patients complete or partial responses were achieved after 6-12 months. Eight of these patients increased their glomerular filtration rate (GFR) by > 25%. The responders were characterized by having shorter nephritis duration, a baseline GFR > 30 ml/min, and detectable circulating CD19+ B lymphocytes before B cell depletion. Anti-CD20 treatment was highly effective in patients with autoimmune thrombocytopenia, inducing a significant increase of platelet counts after 1 month (p < 0.01). Five of 10 patients achieved complete normalization of their platelet counts within 6 months. The anti-CD20 treatment was followed by a significant reduction of autoantibodies against dsDNA and platelets, in nephritic and in thrombocytopenic patients, respectively. CONCLUSION: Addition of anti-CD20 treatment to conventional immunosuppressive therapy may be a beneficial strategy in refractory lupus nephritis and autoimmune cytopenias, possibly by reducing the levels of pathogenic autoantibodies.

Nyckelord

Adolescent

Adult

Aged

Aged

80 and over

Anemia

Hemolytic

blood

drug therapy

immunology

Antibodies

Monoclonal

pharmacology

therapeutic use

Antigens

CD20

drug effects

Autoantibodies

blood

B-Lymphocytes

drug effects

immunology

pathology

Dose-Response Relationship

Drug

Female

Humans

Immunologic Factors

pharmacology

therapeutic use

Lupus Erythematosus

Systemic

blood

drug therapy

immunology

Lupus Nephritis

blood

drug therapy

immunology

Male

Middle Aged

Purpura

Thrombocytopenic

Idiopathic

blood

drug therapy

immunology

Retrospective Studies

Severity of Illness Index

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