Rituximab for the therapy of systemic sclerosis: a series of 10 cases in a single center

Vilela, Verônica Silva; Maretti, Giselle Baptista; Gama, Lívia Marques da Silva; Costa, Cláudia Henrique da; Rufino, Rogério; Levy, Roger A.

doi:10.1016/j.rbre.2016.06.003

Cited by 15 publications

(19 citation statements)

References 18 publications

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“…Some previous small uncontrolled or unadjusted series have suggested some efficacy of rituximab on cutaneous involvement in SSc 5–13 19 29. However, evaluation of drug efficacy in SSc might be difficult because of spontaneous improvement in skin fibrosis during the first years, highlighting the need of control group.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the fatal burden associated with this condition, treatment options for SSc remain limited 4. Preliminary case-reports and series have suggested that rituximab, a chimeric monoclonal antibody targeting B cells, could improve skin and lung fibrosis in SSc 5–19. However, these studies were mostly limited by small samples sizes, lack of control arms, single centre designs, discrepancies in study designs and short durations of follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study

Elhaï

Boubaya

Distler³

et al. 2019

Ann Rheum Dis

151

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ObjectiveTo assess the safety and efficacy of rituximab in systemic sclerosis (SSc) in clinical practice.MethodsWe performed a prospective study including patients with SSc from the European Scleroderma Trials and Research (EUSTAR) network treated with rituximab and matched with untreated patients with SSc. The main outcomes measures were adverse events, skin fibrosis improvement, lung fibrosis worsening and steroids use among propensity score-matched patients treated or not with rituximab.Results254 patients were treated with rituximab, in 58% for lung and in 32% for skin involvement. After a median follow-up of 2 years, about 70% of the patients had no side effect. Comparison of treated patients with 9575 propensity-score matched patients showed that patients treated with rituximab were more likely to have skin fibrosis improvement (22.7 vs 14.03 events per 100 person-years; OR: 2.79 [1.47–5.32]; p=0.002). Treated patients did not have significantly different rates of decrease in forced vital capacity (FVC)>10% (OR: 1.03 [0.55–1.94]; p=0.93) nor in carbon monoxide diffusing capacity (DLCO) decrease. Patients having received rituximab were more prone to stop or decrease steroids (OR: 2.34 [1.56–3.53], p<0.0001). Patients treated concomitantly with mycophenolate mofetil had a trend for better outcomes as compared with patients receiving rituximab alone (delta FVC: 5.22 [0.83–9.62]; p=0.019 as compared with controls vs 3 [0.66–5.35]; p=0.012).ConclusionRituximab use was associated with a good safety profile in this large SSc-cohort. Significant change was observed on skin fibrosis, but not on lung. However, the limitation is the observational design. The potential stabilisation of lung fibrosis by rituximab has to be addressed by a randomised trial.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study

Elhaï

Boubaya

Distler³

et al. 2019

Ann Rheum Dis

151

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“…A small number of studies have evaluated the efficacy of rituximab (RTX) as overall disease therapy in SSc, with suggestions of efficacy in both the skin and the lung (75)(76)(77)(78)(79). An open-label randomized trial in 60 patients with dcSSc and ILD compared monthly pulses of CYC 500 mg/m 2 versus RTX 1,000 mg × 2 doses (80).…”

Section: Rituximabmentioning

confidence: 99%

Expert Perspectives On Clinical Challenges: Expert Perspectives: Challenges in Scleroderma

Simms

2020

Arthritis & Rheumatology

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You are consulted to evaluate a 56‐year‐old woman with known Raynaud's phenomenon, finger swelling of several; months’ duration, and new hypertension with a blood pressure of 160/100 mm/Hg. She also reports progressive shortness of breath. Physical examination reveals telangiectasias, sclerodactyly, and proximal skin sclerosis (thick shiny skin on the chest and upper arms), and bibasilar crackles are found on chest examination. Laboratory tests reveal evidence of microangiopathic hemolytic anemia, thrombocytopenia, and elevation of the serum creatinine level (previously normal), and chest computed tomography shows evidence of ground‐glass opacification in both lower lung fields.

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“…Observational study in patients with SSc using rituximab and analyzed the evolution of pulmonary function tests and videocapilaroscopy. Previously, the authors published a series of 10 patients with diffuse SSc (dSSc) with a disease duration > 3 years who received rituximab for the treatment of SSc skin and lung disease [ 6 ]. Among these, four patients underwent complete longitudinal pulmonary function tests and videocapillaroscopy with a semi-quantitative study performed at baseline, 12 months, and 24 months and were included in the present series.…”

Section: Main Textmentioning

confidence: 99%

“…Stem cell transplantation has been demonstrated to improve and rituximab to stabilize microcirculation in patients with SSc in the early stages of the disease [ 4 , 5 ]. Rituximab is a monoclonal antibody that inhibits B lymphocyte proliferation and is effective in the treatment of several autoimmune diseases [ 6 ]. However, no study has evaluated the effects of rituximab on microcirculation in patients with long term SSc.…”

Section: Introductionmentioning

confidence: 99%

Effects of treatment with rituximab on microcirculation in patients with long-term systemic sclerosis

et al. 2018

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ObjectiveTo investigate the effect of rituximab on microcirculation in long-term SSc.ResultsFour patients with diffuse SSc over 3 years of disease received rituximab cycles of two 1-g infusions every 6 months for 2 years. Videocapillaroscopy was performed at baseline, 12 months, and 24 months and semi-quantitative scoring of videocapillaroscopy abnormalities was performed and the microangiopathy evolution score (MES: range 0–9) was calculated. The mean disease duration was 5 years (range 3–15). On videocapillaroscopy, giant capillaries and hemorrhages remained stable from baseline to 24 months. Capillary loss, abnormally-shaped capillaries, and MES stabilized at 12 months and increased by 24.5% and 28% at 24 months. Rituximab improves microcirculation in long-term SSc. Stabilization and reduced progression of microcirculation abnormalities were achieved at 12 and 24 months, respectively.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3994-1) contains supplementary material, which is available to authorized users.

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Rituximab for the therapy of systemic sclerosis: a series of 10 cases in a single center

Abstract: Similar to findings in previous studies, RTX was effective in treating early and rapidly progressive forms of SSc. We also found that patients with long-term illness may benefit from the treatment.

Cited by 15 publications

References 18 publications

Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study

Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study

Expert Perspectives On Clinical Challenges: Expert Perspectives: Challenges in Scleroderma

Effects of treatment with rituximab on microcirculation in patients with long-term systemic sclerosis

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