Dr. Leandro has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Human Genome Sciences and (more than $10,000) from Roche.
Systemic Lupus Erythematosus
A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at university college london hospital: The first fifty patients
Article first published online: 30 MAR 2009
Copyright © 2009 by the American College of Rheumatology
Arthritis Care & Research
Volume 61, Issue 4, pages 482–487, 15 April 2009
How to Cite
Lu, T. Y.-T., Ng, K. P., Cambridge, G., Leandro, M. J., Edwards, J. C. W., Ehrenstein, M. and Isenberg, D. A. (2009), A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at university college london hospital: The first fifty patients. Arthritis & Rheumatism, 61: 482–487. doi: 10.1002/art.24341
- Issue published online: 30 MAR 2009
- Article first published online: 30 MAR 2009
- Manuscript Accepted: 19 DEC 2008
- Manuscript Received: 2 JUL 2008
To describe the 6-month clinical outcome and the long-term safety profile of B cell depletion therapy (BCDT) in 50 patients with active systemic lupus erythematosus (SLE), who were nonresponsive or poorly responsive to conventional immunosuppression.
All except 4 of 50 patients with active SLE received 1 gm of rituximab, 750 mg of cyclophosphamide, and 100–250 mg of methylprednisolone, administered on 2 occasions 2 weeks apart, to achieve B cell depletion. Clinical outcome was assessed using the British Isles Lupus Assessment Group (BILAG) activity index and serial serologic measurements of disease activity. Remission was defined as a change from a BILAG A or B score to a C or D score in every organ system. Partial remission was a change from a BILAG A or B score to a C or D score in at least 1 system, but with the persistence of 1 score of A or B in another system. No improvement was defined as a BILAG A or B score that remained unchanged after treatment.
Of the 45 patients available for followup at 6 months, 19 patients (42%) achieved remission, and 21 patients (47%) reached partial remission after 1 cycle of BCDT (mean followup 39.6 months). BCDT resulted in a decrease in median global BILAG scores from 12 to 5 (P < 0.0001) and median anti–double-stranded DNA antibody titers from 106 to 42 IU/ml (P < 0.0001), and an increase in the median C3 level from 0.81 to 0.95 mg/liter (P < 0.02) at 6 months. Five serious adverse events were observed.
BCDT is an effective treatment for patients with active SLE whose disease has failed to respond to standard immunosuppressive therapy. Although the safety profile of BCDT is favorable, ongoing monitoring is required.