ANTI-CD 20 THERAPY IN PATIENTS WITH REFRACTORY SYSTEMIC LUPUS ERYTHEMATOSUS: A LONGUITUDINAL ANALYSIS OF 52 PATIENTS

M. Garcia, C. Mendoza, M. Sandoval, A. Beltran, M. Jiménez, D. Graillet, L. Gonzáles, P. Munguía, E. Rocha, J. Rojas, A. Pineda, A. LόpezSystemic Autoimmune Diseases Research Unit Direction of Internal Medicine, HGR 36 IMSS Rheumatology Department, Medicine School of BUAP Hematology Service Direction of Laboratory State Research Department, HGR 36 IMSS, Puebla, MexicoObjectives: To investigate the efficacy and safety of anti-CD20 treatment in patients with refractory systemic lupus erythematosus (SLE) and to determine whether baseline parameters predict disease flare Methods: Fifty two patients with SLE (13 with active lupus nephritis, 11 with thrombocytopenia, 25 with inflammatory polyarthritis and 3 with skin vasculitis) refractory to conventional therapy received anti-CD20 therapy (rituximab; MabThera®, Roche) plus ongoing immunosuppressive treatment. Disease activity was assessed every month using the Systemic Lupus Erythematosus Disease Activity Index validated for the Mexican population (MEX-SLEDAI) with a follow-up of 6 months. Results: At 6 months of follow-up, significant clinical improvements were detected, with a reduction in the global MEXSLEDAI score. Five of the thirteen patients with lupus nephritis (38.4%) had a complete renal response and five (38.4%) had a partial response. Rituximab was also effective in patients with autoimmune thrombocytopenia, inducing a significant increase in platelet counts (p = 0.012). Nineteen out of twenty-five patients with joint involvement had remission of arthritis. Only one of the two patients with skin vasculitis had an absence of lesions at 6 months. Rituximab therapy also allowed a reduction in the oral prednisolone dose in the majority of patients. Treatment was discontinued after the first infusion in two patients due to serum sickness and in one patient due to pulmonary infection Conclusion: The addition of rituximab to conventional immunosuppressive therapy may be an effective strategy in lupus nephritis, autoimmune thrombocytopenia and joint involvement in patients with refractory SLE. Disclosure of Interest: None decleareCitation: Annals of the Rheumatic Diseases, volume 68, supplement 3, year 2009, page 251Session: SLE, Sjgren's and APS Treatment (Poster Presentations )