Rituximab and Lupus – A Promising Pair?

Current Rheumatology Reports

Volumn 16, Issue 9, 2014, Pages

  Ekö, Sara Linder ^a   van Vollenhoven, Ronald F ^a  

^a KAROLINSKA INSTITUTE   (Sweden)

Author keywords

Autoimmune disease; B cell depletion; BCDT; Biologics; EXPLORER; LUNAR; Lupus nephritis; Rituximab; SLE; Systemic lupus erythematosus

Indexed keywords

IMMUNOLOGIC FACTOR; MONOCLONAL ANTIBODY; RITUXIMAB;

B LYMPHOCYTE; HUMAN; IMMUNOLOGY; LUPUS ERYTHEMATOSUS, SYSTEMIC; LUPUS NEPHRITIS; LYMPHOCYTE DEPLETION; PROCEDURES; RANDOMIZED CONTROLLED TRIAL (TOPIC);

ANTIBODIES, MONOCLONAL, MURINE-DERIVED; B-LYMPHOCYTES; HUMANS; IMMUNOLOGIC FACTORS; LUPUS ERYTHEMATOSUS, SYSTEMIC; LUPUS NEPHRITIS; LYMPHOCYTE DEPLETION; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 84904850622     PISSN: 15233774     EISSN: 15346307     Source Type: Journal    
DOI: 10.1007/s11926-014-0444-5     Document Type: Review

References (82)

1. Duarte C, CM, Ines L, Liang MH. Epidemiology of systemic lupus erythematosus, in Systemic Lupus Erythematosus (fifth edition). George Tsokos JPB, Takao Koike and Robert G Lahita Editor. London: Elsevier, 2011 p. 673-96.
2. Yurkovich M et al. Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res (Hoboken). 2014;66(4):608–16.
3. Cervera R et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore). 2003;82(5):299–308.
4. Anolik JH. B cell biology: implications for treatment of systemic lupus erythematosus. Lupus. 2013;22(4):342–9.
5. Chan OT, Madaio MP, Shlomchik MJ. The central and multiple roles of B cells in lupus pathogenesis. Immunol Rev. 1999;169:107–21.
6. Urowitz MB, Gladman DD. How to improve morbidity and mortality in systemic lupus erythematosus. Rheumatology (Oxford). 2000;39(3):238–44.
7. Parker B et al. Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis. 2013;72(8):1308–14.
8. Ruiz-Arruza I, et al. Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2014. doi:10.1093/rheumatology/keu148
9. Ginzler EM et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med. 2005;353(21):2219–28.
10. Mosca M, van Vollenhoven R. New drugs in systemic lupus erythematosus: when to start and when to stop. Clin Exp Rheumatol. 2013;31(4 Suppl 78):S82–5.
11. Ramos-Casals M et al. Rituximab in systemic lupus erythematosus: A systematic review of off-label use in 188 cases. Lupus. 2009;18(9):767–76.
12. Houssiau FA et al. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis Rheum. 2002;46(8):2121–31.
13. Bertsias GK et al. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–82.
14. Strand V et al. Limitations of current treatments for systemic lupus erythematosus: a patient and physician survey. Lupus. 2013;22(8):819–26.
15. Bexelius C et al. Drivers of cost and health-related quality of life in patients with systemic lupus erythematosus (SLE): a Swedish nationwide study based on patient reports. Lupus. 2013;22(8):793–801.
16. Maloney DG et al. Phase I clinical trial using escalating single-dose infusion of chimeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma. Blood. 1994;84(8):2457–66.
17. Emery P et al. Efficacy and safety of different doses and retreatment of rituximab: a randomised, placebo-controlled trial in patients who are biological naive with active rheumatoid arthritis and an inadequate response to methotrexate (Study Evaluating Rituximab's Efficacy in MTX iNadequate rEsponders (SERENE)). Ann Rheum Dis. 2010;69(9):1629–35.
18. Rubbert-Roth A et al. Efficacy and safety of various repeat treatment dosing regimens of rituximab in patients with active rheumatoid arthritis: results of a Phase III randomized study (MIRROR). Rheumatology (Oxford). 2010;49(9):1683–93.
19. Stone JH et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010;363(3):221–32.
20. Anolik JH et al. The relationship of FcgammaRIIIa genotype to degree of B cell depletion by rituximab in the treatment of systemic lupus erythematosus. Arthritis Rheum. 2003;48(2):455–9.
21. Leandro MJ et al. An open study of B lymphocyte depletion in systemic lupus erythematosus. Arthritis Rheum. 2002;46(10):2673–7.
22. van Vollenhoven RF et al. Biopsy-verified response of severe lupus nephritis to treatment with rituximab (anti-CD20 monoclonal antibody) plus cyclophosphamide after biopsy-documented failure to respond to cyclophosphamide alone. Scand J Rheumatol. 2004;33(6):423–7.
23. Merrill JT et al. Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 2010;62(1):222–33.
24. Rovin BH et al. Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study. Arthritis Rheum. 2012;64(4):1215–26. The only RCT evaluating rituximab in lupus nephritis to date. The primary outcome was negative, but the trial demonstrated several positive trends in rituximab’s favor, especially in the long-term perspective.
25. Hahn BH et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken). 2012;64(6):797–808.
26. Murray E, Perry M. Off-label use of rituximab in systemic lupus erythematosus: a systematic review. Clin Rheumatol. 2010;29(7):707–16.
27. Duxbury B, Combescure C, Chizzolini C. Rituximab in systemic lupus erythematosus: an updated systematic review and meta-analysis. Lupus. 2013;22(14):1489–503. A recent systematic review and meta-analysis including data on 1243 patients treated with rituximab for SLE in 30 studies, giving an update on papers published until October 31 2012.
28. Gunnarsson I, Jonsdottir T. Rituximab treatment in lupus nephritis--where do we stand? Lupus. 2013;22(4):381–9. A recent review on the use of rituximab in lupus nephritis, summarizing the current evidence, identifying future research needs, and highlighting the difficulties in studying treatment effects in SLE.
29. Lan L, Han F, Chen JH. Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis. J Zhejiang Univ Sci B. 2012;13(9):731–44.
30. Karim MY et al. Mycophenolate mofetil for systemic lupus erythematosus refractory to other immunosuppressive agents. Rheumatology (Oxford). 2002;41(8):876–82.
31. Terrier B et al. Safety and efficacy of rituximab in systemic lupus erythematosus: results from 136 patients from the French AutoImmunity and Rituximab registry. Arthritis Rheum. 2010;62(8):2458–66.
32. Witt M et al. Clinical outcomes and safety of rituximab treatment for patients with systemic lupus erythematosus (SLE) - results from a nationwide cohort in Germany (GRAID). Lupus. 2013;22(11):1142–9. A recent retrospective registry study on 85 patients in a real-life setting in Germany, confirming a positive benefit–risk ratio for rituximab treatment in SLE patients refractory to standard-of-care.
33. Fernandez-Nebro A et al. Multicenter longitudinal study of B-lymphocyte depletion in refractory systemic lupus erythematosus: the LESIMAB study. Lupus. 2012;21(10):1063–76.
34. Lu TY et al. A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at University College London Hospital: the first fifty patients. Arthritis Rheum. 2009;61(4):482–7.
35. van Vollenhoven RF. Rituximab - shadow, illusion or light? Autoimmun Rev. 2012;11(8):563–7.
36. Ramos-Casals M, Diaz-Lagares C, Khamashta MA. Rituximab and lupus: good in real life, bad in controlled trials. Comment on the article by Lu et al. Arthritis Rheum. 2009;61(9):1281–2.
37. Furtado J, Isenberg DA. B cell elimination in systemic lupus erythematosus. Clin Immunol. 2013;146(2):90–103.
38. van Vollenhoven RF, Parodis I, Levitsky A. Biologics in SLE: towards new approaches. Best Pract Res Clin Rheumatol. 2013;27(3):341–9.
39. Merrill J et al. Assessment of flares in lupus patients enrolled in a phase II/III study of rituximab (EXPLORER). Lupus. 2011;20(7):709–16.
40. Gourley MF et al. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med. 1996;125(7):549–57.
41. Jonsdottir T, et al. Long-term follow-up in lupus nephritis patients treated with rituximab--clinical and histopathological response. Rheumatology (Oxford), 2013;52(5): 847--855.
42. Symmons DP et al. Development and assessment of a computerized index of clinical disease activity in systemic lupus erythematosus. Members of the British Isles Lupus Assessment Group (BILAG). Q J Med. 1988;69(259):927–37.
43. Melander C et al. Rituximab in severe lupus nephritis: early B-cell depletion affects long-term renal outcome. Clin J Am Soc Nephrol. 2009;4(3):579–87.
44. Boletis JN et al. Rituximab and mycophenolate mofetil for relapsing proliferative lupus nephritis: a long-term prospective study. Nephrol Dial Transplant. 2009;24(7):2157–60.
45. Gunnarsson I et al. Histopathologic and clinical outcome of rituximab treatment in patients with cyclophosphamide-resistant proliferative lupus nephritis. Arthritis Rheum. 2007;56(4):1263–72.
46. Li EK et al. Is combination rituximab with cyclophosphamide better than rituximab alone in the treatment of lupus nephritis? Rheumatology (Oxford). 2009;48(8):892–8.
47. Lindholm C et al. Longterm clinical and immunological effects of anti-CD20 treatment in patients with refractory systemic lupus erythematosus. J Rheumatol. 2008;35(5):826–33.
48. Sfikakis PP et al. Remission of proliferative lupus nephritis following B cell depletion therapy is preceded by down-regulation of the T cell costimulatory molecule CD40 ligand: an open-label trial. Arthritis Rheum. 2005;52(2):501–13.
49. Vigna-Perez M et al. Clinical and immunological effects of Rituximab in patients with lupus nephritis refractory to conventional therapy: a pilot study. Arthritis Res Ther. 2006;8(3):R83.
50. Diaz-Lagares C et al. Efficacy of rituximab in 164 patients with biopsy-proven lupus nephritis: pooled data from European cohorts. Autoimmun Rev. 2012;11(5):357–64.
51. Pepper R et al. Rituximab is an effective treatment for lupus nephritis and allows a reduction in maintenance steroids. Nephrol Dial Transplant. 2009;24(12):3717–23.
52. Garcia-Carrasco M et al. Anti-CD20 therapy in patients with refractory systemic lupus erythematosus: a longitudinal analysis of 52 Hispanic patients. Lupus. 2010;19(2):213–9.
53. Catapano F et al. Long-term efficacy and safety of rituximab in refractory and relapsing systemic lupus erythematosus. Nephrol Dial Transplant. 2010;25(11):3586–92.
54. Moroni G et al. Rituximab versus oral cyclophosphamide for treatment of relapses of proliferative lupus nephritis: a clinical observational study. Ann Rheum Dis. 2012;71(10):1751–2.
55. Jonsdottir T et al. Clinical improvements in proliferative vs membranous lupus nephritis following B-cell depletion: pooled data from two cohorts. Rheumatology (Oxford). 2010;49(8):1502–4.
56. Olfat M, Silverman ED, Levy DM. A19: Rituximab Therapy has a Rapid and Durable Response for Refractory Cytopenia in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Rheumatol. 2014;66 Suppl 11:S30.
57. Chen H et al. Low-dose rituximab therapy for refractory thrombocytopenia in patients with systemic lupus erythematosus–a prospective pilot study. Rheumatology (Oxford). 2011;50(9):1640–4.
58. Jovancevic B, Lindholm C, Pullerits R. Anti B-cell therapy against refractory thrombocytopenia in SLE and MCTD patients: long-term follow-up and review of the literature. Lupus. 2013;22(7):664–74.
59. Calderon Saldierna RE et al. [Treatment with rituximab for thrombocytopenia due to systemic lupus erythematosus]. Reumatol Clin. 2010;6(2):82–5.
60. Tokunaga M et al. Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system. Ann Rheum Dis. 2007;66(4):470–5.
61. Narshi CB et al. Rituximab as early therapy for pulmonary haemorrhage in systemic lupus erythematosus. Rheumatology (Oxford). 2010;49(2):392–4.
62. Gonzalez-Echavarri C et al. Severe multiorganic flare of systemic lupus erythematosus successfully treated with rituximab and cyclophosphamide avoiding high doses of prednisone. Lupus. 2014;23(3):323–6.
63. Pinto LF et al. Effective treatment of refractory pulmonary hemorrhage with monoclonal anti-CD20 antibody (rituximab). Respiration. 2009;78(1):106–9.
64. Condon MB et al. Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Ann Rheum Dis. 2013;72(8):1280–6. A study featuring the novel use of rituximab in treating LN patients without oral steroids, demonstrating excellent improvements. If the findings are confirmed in an upcoming RCT, it could mark an important change in SLE treatment.
65. Moroni G, et al. Rituximab vs mycophenolate and vs cyclophosphamide pulses for induction therapy of active lupus nephritis: a clinical observational study. Rheumatology (Oxford), 2014. doi:10.1093/rheumatology/ket462. The first study to compare rituximab without other immunosuppressives with CYC pulses and with MMF in lupus nephritis.
66. Lehman TJ et al. Prolonged improvement of childhood onset systemic lupus erythematosus following systematic administration of rituximab and cyclophosphamide. Pediatr Rheumatol Online J. 2014;12(1):3.
67. Bombardier C et al. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 1992;35(6):630–40.
68. Marengo MF et al. Measuring therapeutic adherence in systemic lupus erythematosus with electronic monitoring. Lupus. 2012;21(11):1158–65.
69. Turner-Stokes T et al. The efficacy of repeated treatment with B-cell depletion therapy in systemic lupus erythematosus: an evaluation. Rheumatology (Oxford). 2011;50(8):1401–8. A sub-study by a group following a relatively large cohort of rituximab-treated SLE patients, giving support to the principle of retreatment with rituximab.
70. Bonilla-Abadia F et al. Rituximab for remission induction and maintenance in refractory systemic lupus erythematosus. Autoimmune Dis. 2014;2014:731806.
71. Houssiau FA, Isenberg D. Towards treating lupus nephritis without oral steroids: a dream-come-true? Ann Rheum Dis. 2013;72(8):1271–2.
72. Gladman DD et al. Accrual of organ damage over time in patients with systemic lupus erythematosus. J Rheumatol. 2003;30(9):1955–9.
73. Fischer-Betz R et al. Renal outcome in patients with lupus nephritis using a steroid-free regimen of monthly intravenous cyclophosphamide: a prospective observational study. J Rheumatol. 2012;39(11):2111–7.
74. Ezeonyeji AN, Isenberg DA. Early treatment with rituximab in newly diagnosed systemic lupus erythematosus patients: a steroid-sparing regimen. Rheumatology (Oxford). 2012;51(3):476–81.
75. Gea-Banacloche JC. Rituximab-associated infections. Semin Hematol. 2010;47(2):187–98.
76. van Vollenhoven RF et al. Long-term safety of rituximab in rheumatoid arthritis: 9.5-year follow-up of the global clinical trial programme with a focus on adverse events of interest in RA patients. Ann Rheum Dis. 2013;72(9):1496–502. A large study evaluating the long-term safety of rituximab in patients receiving treatment for RA, adding more support to the perception of a relatively benign safety profile.
77. Molloy ES, Calabrese LH. Progressive multifocal leukoencephalopathy associated with immunosuppressive therapy in rheumatic diseases: evolving role of biologic therapies. Arthritis Rheum. 2012;64(9):3043–51. A study using the FDA Adverse Event Reporting System to retrieve information on 34 cases of PML in patients with autoimmune rheumatic diseases, giving new insight into this very rare but much-feared complication.
78. Harris HE. Progressive multifocal leucoencephalopathy in a patient with systemic lupus erythematosus treated with rituximab. Rheumatology (Oxford). 2008;47(2):224–5.
79. Clifford DB et al. Rituximab-associated progressive multifocal leukoencephalopathy in rheumatoid arthritis. Arch Neurol. 2011;68(9):1156–64.
80. Brandao M et al. Systemic lupus erythematosus, progressive multifocal leukoencephalopathy, and T-CD4+ lymphopenia. Clin Rev Allergy Immunol. 2012;43(3):302–7.
81. Bonilla-Abadia F et al. Pneumocystis jirovecii pneumonia in two patients with systemic lupus erythematosus after rituximab therapy. Clin Rheumatol. 2014;33(3):415–8.
82. Tsai MJ et al. Pneumocystis jiroveci pneumonia in patients with systemic lupus erythematosus after rituximab therapy. Lupus. 2012;21(8):914–8.