利妥昔单抗治疗红斑狼疮安全有效

作者：Aguiar R, et al.
翻译：北三医院 邓晓莉（13683657545@163.com）
校正：北医三院 张警丰 刘湘源
摘要：目的：描述单中心应用利妥昔单抗治疗重症狼疮或者顽固性狼疮的治疗经验。
方法：回顾性分析单中心接受利妥昔单抗治疗的狼疮患者的资料。临床疗效采用治疗前和治疗半年后BILAG评分、dsDNA抗体滴度、补体C3水平进行评价。同时记录安全性资料、不良反应以及死亡事件。
结果：共115例患者入选，93.9%为女性，初诊年龄为26.39±11.90岁，第一次利妥昔单抗治疗前平均病程为91.96±84.80月。首次利妥昔单抗治疗后BILAG评分平均变化-11.26±11.38 (p<0.001)分；40%的患者完全缓解，27%的患者部分缓解。36.5%的患者中C3上升超过25%，33.5%的患者中dsDNA抗体水平上升超过50%。94.0%的患者CD19 细胞被清除。14.9%的患者出现低丙种球蛋白血症，以IgM和IgG下降最为显著。严重的感染、注射相关并发症以及超敏反应分别见于7%、3.5%以及2.6%的患者。115例患者中，62例重复了利妥昔单抗的治疗，平均治疗次数为1.95±1.17，治疗间隔为21.44±20.11月。随访结束时，11例患者死亡，6例发生心血管事件。
结论：利妥昔单抗能有效降低狼疮患者疾病活动度且副作用较少。
附原文：
OBJECTIVES: To describe the clinical outcomeand safety of rituximab (RTX) treatment in systemic lupus erythematosus (SLE)patients with severe manifestations or refractory to standard immunosuppressivetherapy, treated at a single center. METHODS: This was a retrospective analysisof all patients with SLE treated with RTX at one center between June 2000 andDecember 2013. The clinical outcome was assessed by determining BILAG scores,anti dsDNA and C3 levels before and six months after RTX treatment. For safetyanalysis, adverse events and deaths were recorded.RESULTS: Of a total of 115patients, 93.9% were female; mean age at diagnosis was 26.39±11.90 years: meandisease duration at first RTX treatment was 91.96±84.80 months. A BILAG scorevariation of -11.26±11.38 (p<0.001) was recorded six months after first RTXtreatment; 40% of patients had a complete response and 27% had a partialresponse; in 36.5% of patients, C3 levels increased over 25%, and in 33.5%dsDNA levels decreased over 50%. Depletion of CD19 cells was achieved in 94.0%of patients. Hypogammaglobulinemia was detected in 14.9% of patients, withsignificant reduction for IgM (p<0.001) and IgG (p=0.001) levels. Severeinfections, infusion-related and hypersensitivity reactions occurred in 7%,3.5% and 2.6% of patients. Of the 115 patients, 62 patients had repeated RTXtreatments, with an average number of 1.95±1.17 cycles per patient and a meaninterval between infusions of 21.44±20.11 months. At the end of follow-up, 11patients were deceased; 6 had cardiovascular events. CONCLUSION: RTX treatmentwas effective in decreasing disease activity, with low incidence of adverseeffects.
引自：Aguiar R, Araújo C, Martins-CoelhoG, Isenberg D. Use of rituximab insystemic lupus erythematosus: a single center experienceover 14 years. Arthritis Care Res (Hoboken). 2016 Apr 25.