title: Early treatment with rituximab in newly diagnosed systemic lupus erythematosus patients: a steroid-sparing regimen.
abstract: OBJECTIVE
  To assess the effectiveness of B-cell depletion therapy (BCDT) as a steroid-sparing treatment in newly diagnosed SLE patients.
  
  
  METHODS
  Eight female SLE patients were treated with BCDT using a rituximab/CYC-based regimen aiming to avoid the routine use of oral steroids. Post-treatment, patients were given AZA. The BILAG disease activity index was used for clinical assessment. Serum anti-dsDNA, complement (C3), ESR, circulating B lymphocytes (CD19(+)) and protein : creatinine ratio were tested at 0, 1, 3, 6 and 12 months post-treatment. Disease activity and steroid requirement over the first 6 months of treatment were compared with three SLE patients treated conventionally, each carefully matched for ethnicity, sex, age at disease onset and disease duration at diagnosis.
  
  
  RESULTS
  All patients achieved B-cell depletion (CD19 count <0.005 × 10(9)/l). The mean decrease in global BILAG at 6 months for the BCDT patients was -12.0 vs 13.22 for the controls. Post-BCDT, no patient developed any significant deterioration, mean ESR fell from 70.12 to 17.14 mm/h at 6 months, mean serum anti-dsDNA antibody levels fell by >70% at 1 month and serum C3 level normalized in two patients by 6 months. There were no adverse events. The mean cumulative prednisolone dose at 6 months for the BCDT patients was 1287.3 mg (range 250-4501.8 mg) vs 2834.6 mg (range 0-6802.5 mg) for the controls.
  
  
  CONCLUSIONS
  Early treatment of SLE patients with BCDT is safe and effective and enables a reduction in the overall steroid burden.
authors.affiliation: Department of Rheumatology, University College London Hospital, London NW1 2PG, UK. aezeonyeji@aol.com
authors.forename: Amara N
authors.initials: AN
authors.lastname: Ezeonyeji
authors.forename: David A
authors.initials: DA
authors.lastname: Isenberg
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage* / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001379:Azathioprine / Q000008:administration & dosage; D001402:B-Lymphocytes / Q000166:cytology* / Q000187:drug effects; D001799:Blood Sedimentation; D016022:Case-Control Studies; D003176:Complement C3 / Q000378:metabolism; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D004247:DNA / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy*; D008212:Lymphocyte Depletion; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D000069283:Rituximab; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000888:Antibodies, Anti-Idiotypic; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D003176:Complement C3; D000069283:Rituximab; D003520:Cyclophosphamide; D004247:DNA; D011239:Prednisolone; D001379:Azathioprine