%0 Journal Article
%T Rituximab for Remission Induction and Maintenance in Refractory Systemic Lupus Erythematosus
%A Fabio Bonilla-Abad¨ªa
%A Nicol¨¢s Coronel Restrepo
%A Gabriel J. Tob¨®n
%A Andr¨¦s F. Echeverri
%A Evelyn Mu£¿oz-Buitr¨®n
%A Andres Mauricio Castro
%A Mercedes Andrade Bejarano
%A Carlos A. Ca£¿as
%J Autoimmune Diseases
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/731806
%X Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with high morbidity if untreated. Sometimes, despite aggressive treatments, the disease remains active with cumulative organic damage. We conducted a retrospective and descriptive observational study of patients with SLE refractory to conventional treatment who were treated with rituximab (RTX) as remission induction therapy and maintenance. There was a significant reduction in the conventional immunosuppressive drug dose and the number of relapses of disease. RTX appeared to be effective and safe for the induction and maintenance of remission in patient with SLE refractory to conventional treatment. 1. Introduction Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with no permanent cure or high morbidity if left untreated [1]. Sometimes, despite aggressive treatments with high dose of glucocorticoids and immunosuppressive drugs, the disease remains active with cumulative organic damage [2]. The disease severity appears to be higher in Hispanics compared to Caucasians. Thus, the overall survival rates vary by race and ethnic background with a 5-year survival rate of approximately 95% among whites, 90% among blacks, and 87% among Hispanics [3]. The management of patients with SLE depends on the type of organ involvement and severity of the disease. When manifestations are severe, with threatening life conditions, the treatment is based on high-dose steroids, plasmapheresis, intravenous gamma globulin, and various types of immunosuppressants such as cyclophosphamide, azathioprine, or mofetil mycophenolate [4]. Some patients remain with active disease despite full immunosuppressive drugs. Two monoclonal antibodies targeting B cells have been used successfully in refractory SLE: belimumab directed against B-cell activating factor (BAFF) [5] and Rituximab which is a genetically engineered chimeric anti-CD20 monoclonal antibody. CD20 is a B-cell surface antigen that is expressed only on pre-B and mature B cells. It is not present on stem cells and is lost before differentiation of B cells into plasma cells. Therefore, rituximab causes a selective transient depletion of the CD20+ B-cell subpopulation [6]. Rituximab (RTX) is currently approved for the management of B-cell lymphomas, rheumatoid arthritis (RA) and systemic vasculitis ANCA (antineutrophil cytoplasmic antibodies) positive [7, 8], and it is used as a single dose for SLE crisis with varying results [9¨C11]. There are few reports in the literature about routine and chronic use of RTX as a
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