Rituximab therapy in primary Sjögren's syndrome with interstitial lung disease: a retrospective cohort study.
OBJECTIVE
Interstitial lung disease (ILD) is one of the major systemic manifestations of primary Sjögren's syndrome (pSS). The aim of this study was to evaluate the therapeutic effect of rituximab on pSS patients with ILD.


METHODS
Pulmonary function test results, including diffusing capacity for carbon monoxide (DLCO) and DLCO/alveolar volume (Va) ratio, and high-resolution computed tomography (HRCT) findings/scores in ten pSS patients with ILD treated with rituximab were retrospectively investigated. Global disease, fatigue, dryness of eyes and mouth, shortness of breath, and cough were assessed by visual analogue scales (VAS, 0-100 mm).


RESULTS
At 6 months after rituximab treatment, improvement in pulmonary function was observed (from 49.3±12.6 to 56.9±11.4% for DLCO, p=0.011; from 74.4±15.8 to 85.6±10.3% for DLCO/Va, p=0.021). Similarly, significant improvement of subjective symptoms were also noted after treatment (VAS global disease, from 62.0±11.4 to 26.0±10.8 mm, p<0.001; VAS fatigue, from 38.0±23.0 to 18.0±7.9 mm, p=0.006; VAS dryness of eyes, from 53.0±24.4 to 29.0±13.7 mm, p=0.004; VAS dryness of mouth, from 45.0±14.3 to 28.0±9.2 mm, p=0.001; VAS shortness of breath, from 64.0±16.5 to 31.0±16.0 mm, p<0.001; VAS cough, from 42.0±23.5 to 18.0±10.3 mm, p=0.011). The mean HRCT score decreased after rituximab therapy although to a lesser extent (from 8.7±4.1 to 7.6±4.6, p=0.419). An adverse event was observed in only one patient who had non-fatal pneumonia 4 months after rituximab infusion.


CONCLUSIONS
Rituximab was effective in improving clinical symptoms and gas exchange, and in stabilising HRCT score in pSS patients with ILD.
Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei; and Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Ming-Han
MH
Chen
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Chun-Ku
CK
Chen
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Hsiao-Ping
HP
Chou
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Ming-Huang
MH
Chen
Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei; and Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. cytsai@vghtpe.gov.tw.
Chang-Youh
CY
Tsai
Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei; and Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Deh-Ming
DM
Chang
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D012859:Sjogren's Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D000069283:Rituximab