Early treatment with rituximab in newly diagnosed systemic lupus erythematosus patients: a steroid-sparing regimen

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Objectives. 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 × 109/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.

Conclusion. Early treatment of SLE patients with BCDT is safe and effective and enables a reduction in the overall steroid burden.

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