Rituximab treatment in patients with primary Sjögren's syndrome: an open-label phase II study.
OBJECTIVE
To investigate the safety and efficacy of B cell depletion treatment of patients with active primary Sjögren's syndrome of short duration (early primary SS) and patients with primary SS and mucosa-associated lymphoid tissue (MALT)-type lymphoma (MALT/primary SS).


METHODS
Fifteen patients with primary SS were included in this phase II trial. Inclusion criteria for the early primary SS group were B cell hyperactivity (IgG >15 gm/liter), presence of autoantibodies (IgM rheumatoid factor, anti-SSA/SSB), and short disease duration (<4 years). Inclusion criteria for the MALT/primary SS group were primary SS and an associated MALT-type lymphoma (Ann Arbor stage IE) localized in the parotid gland. Patients were treated with 4 infusions of rituximab (375 mg/m2) given weekly after pretreatment with prednisone (25 mg) and clemastine. Patients were evaluated, using immunologic, salivary/lacrimal function, and subjective parameters, at baseline and at 5 and 12 weeks after the first infusion.


RESULTS
Significant improvement of subjective symptoms and an increase in salivary gland function was observed in patients with residual salivary gland function. Immunologic analysis showed a rapid decrease of peripheral B cells and stable levels of IgG. Human anti-chimeric antibodies (HACAs) developed in 4 of 15 patients (27%), all with early primary SS. Three of these patients developed a serum sickness-like disorder. Of the 7 patients with MALT/primary SS, complete remission was achieved in 3, and disease was stable in 3 and progressive in 1.


CONCLUSIONS
Findings of this phase II study suggest that rituximab is effective in the treatment of primary SS. The high incidence of HACAs and associated side effects observed in this study needs further evaluation.
Pijpe
J
J
Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands. j.pijpe@kchir.umcg.nl
van Imhoff
G W
GW
Spijkervet
F K L
FK
Roodenburg
J L N
JL
Wolbink
G J
GJ
Mansour
K
K
Vissink
A
A
Kallenberg
C G M
CG
Bootsma
H
H
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D006304:Health Status; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007765:Lacrimal Apparatus / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D018442:Lymphoma, B-Cell, Marginal Zone / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000276:immunology / Q000503:physiopathology; D010307:Parotid Neoplasms / Q000473:pathology; D000069283:Rituximab; D012463:Saliva / Q000378:metabolism; D012470:Salivary Glands, Minor / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013666:Tears / Q000378:metabolism; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab