Rituximab therapy for childhood-onset systemic lupus erythematosus.
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.
Willems
M
M
Department of Pediatrics, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
Haddad
E
E
Niaudet
P
P
Koné-Paut
I
I
Bensman
A
A
Cochat
P
P
Deschênes
G
G
Fakhouri
F
F
Leblanc
T
T
Llanas
B
B
Loirat
C
C
Pillet
P
P
Ranchin
B
B
Salomon
R
R
Ulinski
T
T
Bader-Meunier
Brigitte
B
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
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab