title: Rituximab therapy for childhood-onset systemic lupus erythematosus.
abstract: OBJECTIVE
  To describe the safety and efficacy of rituximab in the treatment of childhood-onset systemic lupus erythematosus (SLE).
  
  
  METHODS
  We conducted a French multicenter retrospective study of childhood-onset SLE treated with rituximab.
  
  
  RESULTS
  Eleven girls with severe SLE, including 8 girls with class IV or V lupus nephritis, 2 girls with severe autoimmune cytopenia, and 1 girl with antiprothrombin antibody with severe hemorrhage, were treated with rituximab. The mean age at onset of rituximab treatment was 13.9 years. Patients received 2 to 12 intravenous infusions of rituximab (350-450 mg/m2/infusion), with corticosteroids. Six patients also received different standard immunosuppressive agents, including Cyclophosphamide (2 patients). Remission was achieved in 6 of 8 patients with lupus nephritis and in the 2 patients with autoimmune cytopenia. Steroid therapy was tapered in 5 patients who responded to treatment, and low-dose prednisone treatment was maintained in 1 patient. The mean follow-up period was 13.2 months (range, 6-26 months), and remission lasted in all who patients who responded to treatment, except 1 patient who was successfully retreated with a second course of rituximab. Anti-double-stranded DNA antibody levels decreased in 6 of 11 patients, and anticardiolipin antibody levels decreased in 3 of 4 patients. Severe adverse events developed in 5 patients. Effective depletion of peripheral blood B cells was observed in 7 of 8 patients who were examined, and this paralleled the remission.
  
  
  CONCLUSIONS
  Rituximab may be an effective co-therapy; however, further investigations are required because severe adverse events occurred in 45% of the patients in this study.
authors.affiliation: Department of Pediatrics, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: M
authors.initials: M
authors.lastname: Willems
authors.forename: E
authors.initials: E
authors.lastname: Haddad
authors.forename: P
authors.initials: P
authors.lastname: Niaudet
authors.forename: I
authors.initials: I
authors.lastname: Koné-Paut
authors.forename: A
authors.initials: A
authors.lastname: Bensman
authors.forename: P
authors.initials: P
authors.lastname: Cochat
authors.forename: G
authors.initials: G
authors.lastname: Deschênes
authors.forename: F
authors.initials: F
authors.lastname: Fakhouri
authors.forename: T
authors.initials: T
authors.lastname: Leblanc
authors.forename: B
authors.initials: B
authors.lastname: Llanas
authors.forename: C
authors.initials: C
authors.lastname: Loirat
authors.forename: P
authors.initials: P
authors.lastname: Pillet
authors.forename: B
authors.initials: B
authors.lastname: Ranchin
authors.forename: R
authors.initials: R
authors.lastname: Salomon
authors.forename: T
authors.initials: T
authors.lastname: Ulinski
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bader-Meunier
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D007677:Kidney Function Tests; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D018655:Lymphocyte Count; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab