Outcomes of rituximab therapy in refractory lupus: A meta-analysis

Alshaiki, Fatma; Obaid, Elaf F; Almuallim, Abdulqader; Taha, Rabab; El-Haddad, Hadeel; Almoallim, Hani

doi:10.5152/eurjrheum.2018.17096

Cited by 82 publications

(60 citation statements)

References 71 publications

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“…All first-line therapies, including MMF/MPA (2-3 g/day), 65 CY and CNI (especially TAC) as monotherapy or 'multitarget' therapy, [66][67][68][69] are recommended in non-responding disease. B-cell depleting therapies such as RTX, although off-label, are also indicated either as monotherapy or as add-on therapy to MMF/MPA or CY [70][71][72][73][74] ; complete depletion of circulating B-cells predicted clinical remission at 76 weeks. 75 This has recently been supported by a successful trial of obinutuzumab.…”

Section: Non-responding/refractory Diseasementioning

confidence: 99%

2019 Update of the Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA–EDTA) recommendations for the management of lupus nephritis

et al. 2020

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ObjectiveTo update the 2012 EULAR/ERA–EDTA recommendations for the management of lupus nephritis (LN).MethodsFollowing the EULAR standardised operating procedures, a systematic literature review was performed. Members of a multidisciplinary Task Force voted independently on their level of agreeement with the formed statements.ResultsThe changes include recommendations for treatment targets, use of glucocorticoids and calcineurin inhibitors (CNIs) and management of end-stage kidney disease (ESKD). The target of therapy is complete response (proteinuria <0.5–0.7 g/24 hours with (near-)normal glomerular filtration rate) by 12 months, but this can be extended in patients with baseline nephrotic-range proteinuria. Hydroxychloroquine is recommended with regular ophthalmological monitoring. In active proliferative LN, initial (induction) treatment with mycophenolate mofetil (MMF 2–3 g/day or mycophenolic acid (MPA) at equivalent dose) or low-dose intravenous cyclophosphamide (CY; 500 mg × 6 biweekly doses), both combined with glucocorticoids (pulses of intravenous methylprednisolone, then oral prednisone 0.3–0.5 mg/kg/day) is recommended. MMF/CNI (especially tacrolimus) combination and high-dose CY are alternatives, for patients with nephrotic-range proteinuria and adverse prognostic factors. Subsequent long-term maintenance treatment with MMF or azathioprine should follow, with no or low-dose (<7.5 mg/day) glucocorticoids. The choice of agent depends on the initial regimen and plans for pregnancy. In non-responding disease, switch of induction regimens or rituximab are recommended. In pure membranous LN with nephrotic-range proteinuria or proteinuria >1 g/24 hours despite renin–angiotensin–aldosterone blockade, MMF in combination with glucocorticoids is preferred. Assessment for kidney and extra-renal disease activity, and management of comorbidities is lifelong with repeat kidney biopsy in cases of incomplete response or nephritic flares. In ESKD, transplantation is the preferred kidney replacement option with immunosuppression guided by transplant protocols and/or extra-renal manifestations. Treatment of LN in children follows the same principles as adult disease.ConclusionsWe have updated the EULAR recommendations for the management of LN to facilitate homogenization of patient care.

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Section: Non-responding/refractory Diseasementioning

confidence: 99%

2019 Update of the Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA–EDTA) recommendations for the management of lupus nephritis

et al. 2020

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“…Nevertheless, some studies have reported the efficacy of rituximab for treatment of MG, particularly MuSK-MG (29,30). RTX was approved by USA FDA for treating refractory RA through intravenous infusion (31). It is also an offlabel prescription for the treatment of refractory SLE, and has shown 51% complete remission, and 34% partial remission in SLE and Lupus nephritis (LN) patients (32).…”

Section: Cd20-targeting Mabsmentioning

confidence: 99%

New Approaches to Targeting B Cells for Myasthenia Gravis Therapy

Huda

2020

Front. Immunol.

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Current therapies for myasthenia gravis (MG) are limited, and many investigations have recently focused on target-specific therapies. B cell-targeting monoclonal antibody (mAb) therapies for MG are increasingly attractive due to their specificity and efficacy. The targeted B cell biomarkers are mainly the cluster of differentiation (CD) proteins that mediate maturation, differentiation, or survival of pathogenic B cells. Additional B cell-directed therapies include non-specific peptide inhibitors that preferentially target specific B cell subsets. The primary goals of such therapies are to intercept autoantibodies and prevent the generation of an inflammatory response that contributes to the pathogenesis of MG. Treatment of patients with MG using B cell-directed mAbs, antibody fragments, or selective inhibitors have exhibited moderate to high efficacy in early studies, and some of these therapies appear to be highly promising for further drug development. Numerous other biologics targeting various B cell surface molecules have been approved for the treatment of other conditions or are either in clinical trials or preclinical development stages. These approaches remain to be tested in patients with MG or animal models of the disease. This review article provides an overview of B cell-targeted treatments for MG, including those already available and those still in preclinical and clinical development. We also discuss the potential benefits as well as the shortcomings of these approaches to development of new therapies for MG and future directions in the field.

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“…Данные мета-анализа [52] подтверждают эффективность терапии РТМ при СКВ в целом и при наиболее тяжелом и прогностически неблагоприятном проявлении СКВ -волчаночном нефрите. В мета-анализ были включены 22 исследования, посвященные оценке эффективности РТМ у 866 пациентов с рефрактерным течением СКВ, 10 исследований у 223 пациентов с рефрактерным волчаночным нефритом и 1 исследование у 10 пациентов с нейропсихическими проявлениями СКВ (нейро-люпус).…”

Section: системная красная волчанкаunclassified

Rituximab and other anti-B-cell agents in immune-mediated inflammatory rheumatic diseases

Nasonov¹,

Lila²

2019

CPT

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Disorders of B cell immune tolerance play a central role in the pathogenesis of immune-mediated inflammatory rheumatic diseases. Anti-CD20 monoclonal antibodies (rituximab) and other anti-B cell medications, which induce depletion of B cells and modulate their function, are effective in the wide range of inflammatory rheumatic diseases. Further studies of anti-B cell therapy and identifying the novel targets will improve the efficacy of treatment of immune-mediated rheumatic diseases.

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Outcomes of rituximab therapy in refractory lupus: A meta-analysis

Cited by 82 publications

References 71 publications

2019 Update of the Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA–EDTA) recommendations for the management of lupus nephritis

2019 Update of the Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA–EDTA) recommendations for the management of lupus nephritis

New Approaches to Targeting B Cells for Myasthenia Gravis Therapy

Rituximab and other anti-B-cell agents in immune-mediated inflammatory rheumatic diseases

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