Rituximab therapy for juvenile-onset systemic lupus erythematosus

Obioma Nwobi, Carolyn Abitbol, Jayanthi Chandar, Wacharee Seeherunvong, Gaston E Zilleruelo

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Rituximab (RTX), an anti-CD20 monoclonal antibody, has been proposed for use in the therapy of systemic lupus erythematosus (SLE). We present the initial long-term experience of the safety and efficacy of rituximab for treatment of SLE in children. Eighteen patients (mean age 14±3 years) with severe SLE were treated with rituximab after demonstrating resistance or toxicity to conventional regimens. There was a predominance of female (16/18) and ethnic African (13/18) patients. All had lupus nephritis [World Health Organization (WHO) classes 3-5] and systemic manifestations of vasculitis. Clinical disease activity of the SLE was scored with the SLE-disease activity index 2K (SLEDAI-2K). Patients were followed-up for an average of 3.0±1.3 years (range 0.5 to 4.8 years). B-cell depletion occurred within 2 weeks in all patients and persisted for up to 1 year in some. Clinical activity scores, double-stranded DNA (dsDNA) antibodies, renal function and proteinuria [urine protein to creatinine ratio (Upr/cr)] improved in 93% of the patients. Five patients required multiple courses of RTX for relapse, with B-cell repopulation. One died of infectious endocarditis related to severe immunosuppression. In conclusion, our data support the efficacy of rituximab as adjunctive treatment for SLE in children. Although rituximab was well tolerated by the majority of patients, randomized controlled trials are required to establish its long-term safety and efficacy.

Original languageEnglish
Pages (from-to)413-419
Number of pages7
JournalPediatric Nephrology
Volume23
Issue number3
DOIs
StatePublished - Mar 1 2008

Fingerprint

Systemic Lupus Erythematosus
Therapeutics
B-Lymphocytes
Safety
Systemic Vasculitis
Lupus Nephritis
Endocarditis
Rituximab
Proteinuria
Immunosuppression
Creatinine
Randomized Controlled Trials
Monoclonal Antibodies
Urine
Kidney
Recurrence
Antibodies
Proteins

Keywords

  • Children
  • Rituximab
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Rituximab therapy for juvenile-onset systemic lupus erythematosus. / Nwobi, Obioma; Abitbol, Carolyn; Chandar, Jayanthi; Seeherunvong, Wacharee; Zilleruelo, Gaston E.

In: Pediatric Nephrology, Vol. 23, No. 3, 01.03.2008, p. 413-419.

Research output: Contribution to journalArticle

@article{c4d68e17e1bf4c73b3c527d9506e5572,
title = "Rituximab therapy for juvenile-onset systemic lupus erythematosus",
abstract = "Rituximab (RTX), an anti-CD20 monoclonal antibody, has been proposed for use in the therapy of systemic lupus erythematosus (SLE). We present the initial long-term experience of the safety and efficacy of rituximab for treatment of SLE in children. Eighteen patients (mean age 14±3 years) with severe SLE were treated with rituximab after demonstrating resistance or toxicity to conventional regimens. There was a predominance of female (16/18) and ethnic African (13/18) patients. All had lupus nephritis [World Health Organization (WHO) classes 3-5] and systemic manifestations of vasculitis. Clinical disease activity of the SLE was scored with the SLE-disease activity index 2K (SLEDAI-2K). Patients were followed-up for an average of 3.0±1.3 years (range 0.5 to 4.8 years). B-cell depletion occurred within 2 weeks in all patients and persisted for up to 1 year in some. Clinical activity scores, double-stranded DNA (dsDNA) antibodies, renal function and proteinuria [urine protein to creatinine ratio (Upr/cr)] improved in 93{\%} of the patients. Five patients required multiple courses of RTX for relapse, with B-cell repopulation. One died of infectious endocarditis related to severe immunosuppression. In conclusion, our data support the efficacy of rituximab as adjunctive treatment for SLE in children. Although rituximab was well tolerated by the majority of patients, randomized controlled trials are required to establish its long-term safety and efficacy.",
keywords = "Children, Rituximab, Systemic lupus erythematosus",
author = "Obioma Nwobi and Carolyn Abitbol and Jayanthi Chandar and Wacharee Seeherunvong and Zilleruelo, {Gaston E}",
year = "2008",
month = "3",
day = "1",
doi = "10.1007/s00467-007-0694-9",
language = "English",
volume = "23",
pages = "413--419",
journal = "Pediatric Nephrology",
issn = "0931-041X",
publisher = "Springer Verlag",
number = "3",

}

TY - JOUR

T1 - Rituximab therapy for juvenile-onset systemic lupus erythematosus

AU - Nwobi, Obioma

AU - Abitbol, Carolyn

AU - Chandar, Jayanthi

AU - Seeherunvong, Wacharee

AU - Zilleruelo, Gaston E

PY - 2008/3/1

Y1 - 2008/3/1

N2 - Rituximab (RTX), an anti-CD20 monoclonal antibody, has been proposed for use in the therapy of systemic lupus erythematosus (SLE). We present the initial long-term experience of the safety and efficacy of rituximab for treatment of SLE in children. Eighteen patients (mean age 14±3 years) with severe SLE were treated with rituximab after demonstrating resistance or toxicity to conventional regimens. There was a predominance of female (16/18) and ethnic African (13/18) patients. All had lupus nephritis [World Health Organization (WHO) classes 3-5] and systemic manifestations of vasculitis. Clinical disease activity of the SLE was scored with the SLE-disease activity index 2K (SLEDAI-2K). Patients were followed-up for an average of 3.0±1.3 years (range 0.5 to 4.8 years). B-cell depletion occurred within 2 weeks in all patients and persisted for up to 1 year in some. Clinical activity scores, double-stranded DNA (dsDNA) antibodies, renal function and proteinuria [urine protein to creatinine ratio (Upr/cr)] improved in 93% of the patients. Five patients required multiple courses of RTX for relapse, with B-cell repopulation. One died of infectious endocarditis related to severe immunosuppression. In conclusion, our data support the efficacy of rituximab as adjunctive treatment for SLE in children. Although rituximab was well tolerated by the majority of patients, randomized controlled trials are required to establish its long-term safety and efficacy.

AB - Rituximab (RTX), an anti-CD20 monoclonal antibody, has been proposed for use in the therapy of systemic lupus erythematosus (SLE). We present the initial long-term experience of the safety and efficacy of rituximab for treatment of SLE in children. Eighteen patients (mean age 14±3 years) with severe SLE were treated with rituximab after demonstrating resistance or toxicity to conventional regimens. There was a predominance of female (16/18) and ethnic African (13/18) patients. All had lupus nephritis [World Health Organization (WHO) classes 3-5] and systemic manifestations of vasculitis. Clinical disease activity of the SLE was scored with the SLE-disease activity index 2K (SLEDAI-2K). Patients were followed-up for an average of 3.0±1.3 years (range 0.5 to 4.8 years). B-cell depletion occurred within 2 weeks in all patients and persisted for up to 1 year in some. Clinical activity scores, double-stranded DNA (dsDNA) antibodies, renal function and proteinuria [urine protein to creatinine ratio (Upr/cr)] improved in 93% of the patients. Five patients required multiple courses of RTX for relapse, with B-cell repopulation. One died of infectious endocarditis related to severe immunosuppression. In conclusion, our data support the efficacy of rituximab as adjunctive treatment for SLE in children. Although rituximab was well tolerated by the majority of patients, randomized controlled trials are required to establish its long-term safety and efficacy.

KW - Children

KW - Rituximab

KW - Systemic lupus erythematosus

UR - http://www.scopus.com/inward/record.url?scp=38649104136&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38649104136&partnerID=8YFLogxK

U2 - 10.1007/s00467-007-0694-9

DO - 10.1007/s00467-007-0694-9

M3 - Article

VL - 23

SP - 413

EP - 419

JO - Pediatric Nephrology

JF - Pediatric Nephrology

SN - 0931-041X

IS - 3

ER -