title: Should rituximab be considered as the first-choice treatment for severe autoimmune rheumatic diseases?
abstract: The present study aimed to assess the tolerance and efficacy of rituximab (RTX), a chimeric IgG1 monoclonal antibody directed against the CD20 receptor present in B lymphocytes, in patients with autoimmune rheumatic diseases (AIRD). For this purpose, patients treated with RTX and their respective clinical charts were comprehensively examined. Indications for treatment were a refractory character of the disease, inefficacy or intolerance of other immunosuppressors. Activity indexes (SLEDAI, DAS28, and specific clinical manifestations) were used to evaluate efficacy. Serious side effects were also recorded. Seventy-four patients were included. Forty-three patients had systemic lupus erythematosus (SLE), 21 had rheumatoid arthritis (RA), 8 had Sjögren's syndrome (SS), and 2 had Takayasu's arteritis (TA). RTX was well-tolerated in 66 (89%) patients. In 8 patients (SLE=3, SS=3, RA=2), serious side effects lead to discontinuation. The mean follow-up period was 12+/-7.8 (2-35) months. The efficacy of RTX was registered in 58/66 (87%) patients, of whom 36 (83%) had SLE, 18/21 (85%) had RA, 3/8 (37%) had SS, and 1 had TA. The mean time of efficacy was 6.3+/-5.1 weeks. A significant steroid-sparing effect was noticed in half of the patients. These results add further evidence for the use of RTX in AIRD. Based on its risk-benefit ratio, RTX might be used as the first-choice treatment for patients with severe AIRD.
authors.affiliation: Unidad de Enfermedades Reumáticas y Autoinmunes (UNERA), Hospital Monte Sinai, Cuenca, Guayaquil, Ecuador.
authors.forename: Claudio
authors.initials: C
authors.lastname: Galarza
authors.forename: Diana
authors.initials: D
authors.lastname: Valencia
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Tobón
authors.forename: Luis
authors.initials: L
authors.lastname: Zurita
authors.forename: Rubén D
authors.initials: RD
authors.lastname: Mantilla
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pineda-Tamayo
authors.forename: Adriana
authors.initials: A
authors.lastname: Rojas-Villarraga
authors.forename: Juan C
authors.initials: JC
authors.lastname: Rueda
authors.forename: Juan-Manuel
authors.initials: JM
authors.lastname: Anaya
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000276:immunology; D000069283:Rituximab; D012859:Sjogren's Syndrome / Q000188:drug therapy / Q000276:immunology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab