Rituximab Therapy in Refractory Neuropsychiatric Lupus: Current Clinical Evidence
Seminars in Arthritis and Rheumatism, 08/31/2011
Narvaez J et al. – Evidence for the effectiveness of rituximab (RTX) as induction therapy in neuropsychiatric systemic lupus erythematosus (NPSLE) is based solely on several case reports and noncontrolled trials. Although it is not yet possible to make definite recommendations, the global analysis of these cases supports the off–label use of RTX in cases of severe refractory NPSLE.
Methods- The authors describe a patient with persistently active NPSLE, despite conventional therapy, who responded dramatically to RTX.
- Current evidence on the therapeutic use of RTX in this complex situation is also analyzed through a systematic review of the English–language literature, based on a PubMed search.
- Available data on the use of RTX in refractory NPSLE come from a large number of case reports and some open–label studies.
- Including the case, 35 patients have been well documented.
- A complete or partial therapeutic response was achieved in 85% of patients after 1 cycle of treatment.
- A positive correlation between serological markers of disease activity and clinical outcome has also been demonstrated in some of these patients.
- Clinical improvement was accompanied by a significant reduction in the daily dose of oral corticosteroids.
- Relapse after RTX treatment was noted in 45% of cases (median 9.5 months; range, 4–33 months). Infections were observed in 29% of patients.
