B cell depletion with rituximab in patients with diffuse cutaneous systemic sclerosis
Article first published online: 29 JAN 2009
Copyright © 2009 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 60, Issue 2, pages 578–583, February 2009
How to Cite
Lafyatis, R., Kissin, E., York, M., Farina, G., Viger, K., Fritzler, M. J., Merkel, P. A. and Simms, R. W. (2009), B cell depletion with rituximab in patients with diffuse cutaneous systemic sclerosis. Arthritis & Rheumatism, 60: 578–583. doi: 10.1002/art.24249
- Issue published online: 29 JAN 2009
- Article first published online: 29 JAN 2009
- Manuscript Accepted: 13 OCT 2008
- Manuscript Received: 13 MAR 2008
- Genentech and Biogen Idec
- NIH (The Boston University Medical Center General Clinical Research Center). Grant Numbers: U01-AR-055063, M01-RR-00533
To determine the safety of rituximab, to provide preliminary data regarding the potential efficacy of rituximab, and to investigate the effects of rituximab on autoimmunity and fibrosis in patients with diffuse cutaneous systemic sclerosis (dcSSc).
Fifteen patients with dcSSc, all of whom experienced their first non–Raynaud's disease–associated disease manifestation within 18 months of trial entry, were recruited to receive 2 intravenous doses of rituximab (1,000 mg), administered 2 weeks apart. Safety, clinical, and exploratory outcomes were evaluated at baseline and at 6 months. The primary outcome was the change in the modified Rodnan skin thickness score (MRSS) at 6 months compared with baseline.
Adverse events included frequent infusion reactions and rare infections (urinary tract infection and dental abscess occurred in 1 patient each). The mean change in the MRSS between baseline and 6 months was not significant. Results of pulmonary function tests and other measures of major organ involvement were stable. The modest B cell infiltrates that were present in most skin biopsy specimens at baseline were completely depleted at 6 months in most patients. Autoantibody titers showed only modest and variable changes after treatment.
In this pilot study, treatment with rituximab appeared to be safe and well tolerated among patients with dcSSc. Rituximab treatment resulted in both depletion of circulating B cells and depletion of dermal B cells but had little effect on the levels of SSc-associated autoantibodies. Rituximab treatment did not appear to result in a significant beneficial effect on skin disease. The potential efficacy of rituximab in other organs such as the lung could not be clearly evaluated in this small open-label trial.