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Treatment of refractory SLE with rituximab plus cyclophosphamide: clinical effects, serological changes, and predictors of response
Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.ORCID iD: 0000-0002-4258-5348
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2008 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 67, no 3, p. 330-334Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate efficacy, serological responses, and predictors of response in patients with severe and refractory systemic lupus erythematosus (SLE) treated with rituximab plus cyclophosphamide.

METHODS: 16 patients entered a treatment protocol using rituximab plus cyclophosphamide. Disease activity was assessed by the SLE disease activity index (SLEDAI) and by the British Isles Lupus Assessment Group (BILAG) index.

RESULTS: At six months follow up, mean SLEDAI values decreased significantly from (mean (SD)) 12.1 (2.2) to 4.7 (1.1). Clinical improvement (50% reduction in SLEDAI) occurred in all but three patients. All but one patient responded according to BILAG. Remission defined as SLEDAI <3 was achieved in nine of 16 patients. Isotype analysis of anti-dsDNA antibodies revealed preferential decreases of IgG and IgA, but not IgM. Higher absolute numbers of CD19+ cells at baseline were correlated with shorter depletion time (r = -0.6).

CONCLUSIONS: The majority of patients improved following rituximab plus cyclophosphamide. The differential downregulation of anti-DNA of the IgG and IgA but not the IgM isotypes supports the hypothesis that cells producing pathogenic autoantibodies are preferentially targeted by the treatment. The fact that greater absolute numbers of CD19+ cells at baseline predict a less impressive clinical and serological response suggests that more flexible dosing could be advantageous.

Place, publisher, year, edition, pages
HighWire Press , 2008. Vol. 67, no 3, p. 330-334
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
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URN: urn:nbn:se:oru:diva-70550DOI: 10.1136/ard.2007.079095ISI: 000253443600009PubMedID: 17827182Scopus ID: 2-s2.0-39549108298OAI: oai:DiVA.org:oru-70550DiVA, id: diva2:1298559
Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-03-26Bibliographically approved

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Welin Henriksson, Elisabet

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