title: Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system.
abstract: OBJECTIVE
  Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious treatment-resistant phenotype of systemic lupus erythematosus. A standard treatment for NPSLE is not available. This report describes the clinical and laboratory tests of 10 patients with NPSLE before and after rituximab treatment, including changes in lymphocyte phenotypes.
  
  
  METHODS
  Rituximab was administered at different doses in 10 patients with refractory NPSLE, despite intensive treatment.
  
  
  RESULTS
  Treatment with rituximab resulted in rapid improvement of central nervous system-related manifestations, particularly acute confusional state. Rituximab also improved cognitive dysfunction, psychosis and seizure, and reduced the SLE Disease Activity Index Score at day 28 in all 10 patients. These effects lasted for >1 year in five patients. Flow cytometric analysis showed that rituximab down regulated CD40 and CD80 on B cells and CD40L, CD69 and inducible costimulator on CD4+ T cells.
  
  
  CONCLUSIONS
  Rituximab rapidly improved refractory NPSLE, as evident by resolution of various clinical signs and symptoms and improvement of radiographic findings. The down regulation of functional molecules on B and T cells suggests that rituximab modulates the interaction of activated B and T cells through costimulatory molecules. These results warrant further analysis of rituximab as treatment for NPSLE.
authors.affiliation: The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka Yahata-nishi, Kitakyushu 807-8555 Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawabata
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Imura
authors.forename: Takao
authors.initials: T
authors.lastname: Fujii
authors.forename: Shingo
authors.initials: S
authors.lastname: Nakayamada
authors.forename: Shizuyo
authors.initials: S
authors.lastname: Tsujimura
authors.forename: Masao
authors.initials: M
authors.lastname: Nawata
authors.forename: Shigeru
authors.initials: S
authors.lastname: Iwata
authors.forename: Taeko
authors.initials: T
authors.lastname: Azuma
authors.forename: Tsuneyo
authors.initials: T
authors.lastname: Mimori
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000097:blood*; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D020945:Lupus Vasculitis, Central Nervous System / Q000188:drug therapy* / Q000276:immunology; D008212:Lymphocyte Depletion / Q000379:methods; D016131:Lymphocyte Subsets / Q000187:drug effects / Q000276:immunology; D008875:Middle Aged; D000069283:Rituximab; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000069283:Rituximab