Rituximab in systemic lupus erythematosus: A systematic review of off-label use in 188 cases.

Abstract:

:The complexity of the therapeutic approach in systemic lupus erythematosus (SLE) is increased by the large number of patients who do not respond to the first-line therapies and by relapses after initial clinical remission. In these patients, second-line drugs are often prescribed according to individual clinical decisions. The emergence of biological therapies has increased the therapeutic armamentarium available in these complex situations, but their use is limited by the lack of licensing. Available data on the use of rituximab in SLE rely on a large number of case reports and some observational studies. We analyzed current evidence on the therapeutic use of rituximab in adult SLE patients by a systematic review of reports included in the PubMed database between 2002 and 2007. A total of 188 SLE patients treated with rituximab were identified; 171 (91%) patients showed a significant improvement in one or more of the systemic SLE manifestations. There were 103 patients with lupus nephritis, with an overall rate of therapeutic response of renal involvement of 91%. Adverse events were reported in 44 (23%) patients; the most frequent were infections (19%). Although it is not yet possible to make definite recommendations, the global analysis of all cases reported to date support the off-label use of rituximab in severe, refractory SLE cases, whereas its use as a first-line therapy or in patients with a predominantly mild form of the disease is not advised.

journal_name

Lupus

journal_title

Lupus

authors

Ramos-Casals M,Soto MJ,Cuadrado MJ,Khamashta MA

doi

10.1177/0961203309106174

subject

Has Abstract

pub_date

2009-08-01 00:00:00

pages

767-76

issue

9

eissn

0961-2033

issn

1477-0962

pii

18/9/767

journal_volume

18

pub_type

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