Is There a Role for B-cell Depletion as Therapy for Scleroderma? A Case Report and Review of the Literature

Daoussis, Dimitrios; Liossis, Stamatis–Nick C.; Tsamandas, Athanassios C.; Kalogeropoulou, Christina; Kazantzi, Alexandra; Korfiatis, Panagiotis; Yiannopoulos, Georgios; Andonopoulos, Andrew P.

doi:10.1016/j.semarthrit.2009.09.003

Cited by 51 publications

(31 citation statements)

References 45 publications

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“…The above findings are in some measure comparable with that emerging from the updated review of the world literature on the RTX treatment in SSc patients [17,18,[20][21][22][23][24][25][26][27][28][29][30][31][32]. A limited number of openlabel, uncontrolled trials are generally referred to small patients' series; while only one multicentre study evaluated the effects of RTX in a larger number of scleroderma patients [31].…”

Section: Discussionsupporting

confidence: 70%

“…Available data from the world literature regarding the RTX treatment in SSc patients comprises 15 reports [17,18,[20][21][22][23][24][25][26][27][28][29][30][31][32], which are carefully summarized in the Table 3. It includes 6 single case reports [17,22,[24][25][26]29] and 9 open-label, uncontrolled trials [18,20,21,23,27,28,[30][31][32]; these latter generally reported small patients' series (from 5 to 20 pts), with the exception of one multicentre study reporting the effects of RTX in a large series scleroderma patients [31].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…It includes 6 single case reports [17,22,[24][25][26]29] and 9 open-label, uncontrolled trials [18,20,21,23,27,28,[30][31][32]; these latter generally reported small patients' series (from 5 to 20 pts), with the exception of one multicentre study reporting the effects of RTX in a large series scleroderma patients [31]. The indications to RTX treatment were generally lung fibrosis and/or skin sclerosis, and less frequently severe calcinosis or arthritis (Table 3); while, the dosage and modalities of drug administration and the number of RTX cycles, as well as the duration of patient's clinical follow-up after RTX treatment largely varied among different studies (Table 3).…”

Section: Review Of the Literaturementioning

confidence: 99%

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Rituximab in the treatment of patients with systemic sclerosis. Our experience and review of the literature

Giuggioli

Lumetti

Colaci

et al. 2015

Autoimmunity Reviews

136

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Section: Discussionsupporting

confidence: 70%

Section: Review Of the Literaturementioning

confidence: 99%

Section: Review Of the Literaturementioning

confidence: 99%

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Rituximab in the treatment of patients with systemic sclerosis. Our experience and review of the literature

Giuggioli

Lumetti

Colaci

et al. 2015

Autoimmunity Reviews

136

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“…Evidence for the effectiveness of rituximab as ''rescue'' therapy in patients with severe, life-threatening ILD is limited [20,21]. We report the use of rituximab as rescue therapy in eight patients with underlying features of CTD, and exceedingly severe fibrotic lung disease, progressing in spite of vigorous conventional immunosuppression.…”

Section: Abstract: Collagen Vascular Disease Interstitial Lung Diseasesmentioning

confidence: 99%

Severe interstitial lung disease in connective tissue disease: rituximab as rescue therapy

et al. 2012

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In very severe interstitial lung disease associated with connective tissue disease (CTD-ILD), progressing despite maximal conventional immunosuppression, there is no effective medical rescue therapy.The aim of the present study was to test whether rituximab, a monoclonal antibody that depletes peripheral B lymphocytes, is effective as rescue therapy in very severe CTD-ILD, unresponsive to conventional immunosuppression.We performed a retrospective assessment of eight patients with severe and progressive CTD-ILD treated with rituximab. In six patients, change in pulmonary function tests (PFTs) compared with pre-rituximab levels, was assessed at 9-12 months post-treatment. In two patients, who were mechanically ventilated at the time of treatment, clinical and HRCT changes were assessed.Seven out of eight patients had a favourable treatment response to rituximab, while in one patient disease severity did not change. In contrast with previous progression, we observed a median significant improvement of 22% in diffusing capacity for carbon monoxide (from a median baseline of 25%; range 16-32%; p50.04), and a median significant improvement of 18% in forced vital capacity (from a median baseline of 45%; range 37-59%; p50.03), in the 9-12 months following treatment with rituximab.In very severe CTD-ILD unresponsive to conventional immunosuppression, rituximab may represent an effective, potentially life-saving, therapeutic intervention.

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“…Since elevated levels of B lymphocytes have been described in the lung of patients with SSc-ILD, there is a strong rational for the use of RTX [37]. The beneficial effects of RTX on SSc-ILD have been documented in three case reports [38][39][40]. Some small, open-label clinical studies have explored the potential clinical efficacy of RTX in SSc.…”

Section: Biological Immunotherapies Rituximabmentioning

confidence: 99%

Immunosuppression for interstitial lung disease in systemic sclerosis

Cappelli¹,

Guiducci²,

Randone³

et al. 2013

European Respiratory Review

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The efficacy of immunosuppressors in the treatment of systemic sclerosis-interstitial lung disease is still matter of controversy. In this review we will analyse the evidence that immunosuppressors, despite not being able to reverse fibrotic changes, may help in slowing disease progression. Induction treatment with cyclophosphamide should be started as soon as possible in patients at risk for progression. Mycophenolate mofetil and rituximab have to be considered in patients who are unable to tolerate cyclophosphamide. After remission, maintenance treatment with mycophenolate mofetil or azathioprine should be started in order to preserve the benefits achieved during the induction treatment. @ERSpublications SSc-ILD therapy consists of induction treatment and maintenance with mycophenolate mofetil or azathioprine

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Is There a Role for B-cell Depletion as Therapy for Scleroderma? A Case Report and Review of the Literature

Cited by 51 publications

References 45 publications

Rituximab in the treatment of patients with systemic sclerosis. Our experience and review of the literature

Rituximab in the treatment of patients with systemic sclerosis. Our experience and review of the literature

Severe interstitial lung disease in connective tissue disease: rituximab as rescue therapy

Immunosuppression for interstitial lung disease in systemic sclerosis

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