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Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register

Lookup NU author(s): Dr Bridget Griffiths

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Abstract

© The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Objectives. To describe the baseline characteristics of SLE patients requiring biologic therapy in the UK and to explore short term efficacy and infection rates associated with rituximab (RTX) use. Methods. Patients commencing biologic therapy for refractory SLE and who consented to join BILAG-BR were analysed. Baseline characteristics, disease activity (BILAG 2004/SLEDAI-2K) and rates of infection over follow-up were analysed. Response was defined as loss of all A and B BILAG scores to41 B score with no new A/B scores in other organ systems at 6 months. Results. Two hundred and seventy SLE patients commenced biologic therapy from September 2010 to September 2015, most commonly RTX (n = 261). Two hundred and fifty (93%) patients were taking glucocorticoids at baseline at a median [interquartile range (IQR)] oral dose of 10mg (5-20 mg) daily. Response rates at 6 months were available for 68% of patients. The median (IQR) BILAG score was 15 (10-23) at baseline and 3 (2-12) at 6 months (P<0.0001). The median (IQR) SLEDAI-2K reduced from 8 (5-12) to 4 (0-7) (P<0.001). Response was achieved in 49% of patients. There was also a reduction in glucocorticoid use to a median (IQR) dose of 7.5mg (5-12 mg) at 6 months (P< 0.001). Serious infections occurred in 26 (10%) patients, being more frequent in the first 3 months post-RTX therapy. A higher proportion of early infections were non-respiratory (odds ratio = 1.98, 95% CI: 0.99, 3.9; P = 0.049). Conclusion. RTX is safe and is associated with improvement in disease activity in refractory SLE patients with concomitant reductions in glucocorticoid use. Early vigilance for infection post-infusion is important to further improve treatment risks and benefits.


Publication metadata

Author(s): McCarthy EM, Sutton E, Nesbit S, White J, Parker B, Jayne D, Griffiths B, Isenberg WA, Rahman A, Gordon C, D'Cruz DP, Rhodes B, Lanyon P, Vital EM, Yee C-S, Edwards CJ, Teh L-S, Akil M, McHugh NJ, Zoma A, Bruce IN, Gordon P, Young-Min S, Stevens R, Prabu A, Batley M, Gendi N, Dasgupta B, Khamashta M, Hewins P, Stratton RJ, Chan A, De Lord D, King J, Dubey S, O'Riordan E, Shaffu S, Laversuch C, Sheeran TP, Vermaak E, Erb N, Pyne D, Jeffrey R, Youssef H, Al-Allaf W, Regan M, Kaul A

Publication type: Article

Publication status: Published

Journal: Rheumatology

Year: 2018

Volume: 57

Issue: 3

Pages: 470-479

Print publication date: 01/03/2018

Online publication date: 05/12/2017

Acceptance date: 02/04/2016

ISSN (print): 1462-0324

ISSN (electronic): 1462-0332

Publisher: Oxford University Press

URL: https://doi.org/10.1093/rheumatology/kex395

DOI: 10.1093/rheumatology/kex395


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