title: The administration of low doses of rituximab followed by hydroxychloroquine, prednisone and low doses of mycophenolate mofetil is an effective therapy in Latin American patients with active systemic lupus erythematosus.
abstract: BACKGROUND
  In Latin America, the medical attention directed to systemic autoimmune diseases competes with a budget designed to fight poverty, lack of education, etc. In this context, the access to treatments recommended internationally are expensive and limited; therefore, research of methods that make these treatments cheaper is of paramount importance.
  
  
  OBJECTIVE
  Our objective was to describe the 24-month clinical outcome of patients with active systemic lupus erythematosus (SLE) who received low doses of rituximab (RTX), followed by hydroxychloroquine (HCQ), prednisone and low doses of mycophenolate mofetil (MMF).
  
  
  METHODS
  Forty-six patients with active SLE received 500 mg of RTX (together with 500 mg of methylprednisolone as a premedication) administered on two occasions 2 weeks apart, followed by HCQ (200-400 mg/day), prednisone and MMF (500-1000 mg/day) during a 24-month follow-up period. Clinical outcome was assessed using the MEX-SLE Disease Activity Index (MEX-SLEDAI) and serial serologic measurements. Remission was defined as MEX-SLEDAI scores 0-1, mild disease activity 2-5, moderate disease activity 6-9, severe 10-13, and very severe 14 or more.
  
  
  RESULTS
  Disease activity decreased over time with treatment. At baseline, 19 (41.3%) patients had very severe, 16 (34.8%) severe, and 9 (19.6%) moderate disease activity. Improvement on disease activity was detected at 3 months, since 9 (19.6%) patients reached disease remission after this period of time and remission increased to 16 (34.8%) patients at 6 months, 19 (41.3%) at 1 year, and 23 (50%) at 2 years of follow-up (p<0.0001).
  
  
  CONCLUSIONS
  The administration of low doses of RTX followed by HCQ, prednisone and low doses of MMF is an effective therapy in Latin American patients with active SLE.
authors.affiliation: Unidad de Enfermedades Reumáticas y Autoinmunes (UNERA), Hospital Monte Sinaí, Cuenca, Ecuador.
authors.forename: Claudio
authors.initials: C
authors.lastname: Galarza-Maldonado
authors.forename: María R
authors.initials: MR
authors.lastname: Kourilovitch
authors.forename: Julio E
authors.initials: JE
authors.lastname: Molineros
authors.forename: Mario H
authors.initials: MH
authors.lastname: Cardiel
authors.forename: Luis
authors.initials: L
authors.lastname: Zurita
authors.forename: Nikolay F
authors.initials: NF
authors.lastname: Soroka
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Yagur
authors.forename: Natalia
authors.initials: N
authors.lastname: Doukh
authors.forename: Ricard
authors.initials: R
authors.lastname: Cervera
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004484:Ecuador; D006801:Humans; D006886:Hydroxychloroquine / Q000008:administration & dosage* / Q000627:therapeutic use; D007843:Latin America; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage* / Q000627:therapeutic use; D000069283:Rituximab; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D006886:Hydroxychloroquine; D009173:Mycophenolic Acid; D011241:Prednisone