Document Detail


Longterm clinical and immunological effects of anti-CD20 treatment in patients with refractory systemic lupus erythematosus.
MedLine Citation:
PMID:  18398943     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Catharina Lindholm; Katharina Börjesson-Asp; Kiandokht Zendjanchi; Anna-Carin Sundqvist; Andrej Tarkowski; Maria Bokarewa
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-04-01
Journal Detail:
Title:  The Journal of rheumatology     Volume:  35     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-08     Completed Date:  2008-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  826-33     Citation Subset:  IM    
Affiliation:
Department of Rheumatology and Inflammation Research, Göteborg University, Gothenburg, Sweden. catharina.lindholm@rheuma.gu.se
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MeSH Terms
Descriptor/Qualifier:
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
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antigens, CD20; 0/Autoantibodies; 0/Immunologic Factors; 0/rituximab

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