Treating severe systemic lupus erythematosus with rituximab. An open study
Tratamiento del lupus eritematoso severo con rituximab. Un estudio abierto
Carlos Abud-Mendozaa,
, Ricardo Moreno-Valdésa, Enrique Cuevas-Ortaa, Antonio Borjasa, Francisco Arandaa, Fedra Irazoqueb, Lilia Andradeb, M. Vigna-Pérezc, R. González-Amaroc
Corresponding author
a Unidad Regional de Reumatología y Osteoporosis, Facultad de Medicina y Hospital Central “Dr. Ignacio Morones Prieto,” San Luis Potosí, S.L.P., Mexico
b Servicio de Reumatología, Hospital General “20 de Noviembre,” ISSSTE, México, D.F., Mexico
c Servicio de Inmunología, Facultad de Medicina, UASLP, San Luis Potosí, S.L.P., Mexico
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"apellidos" => "González-Amaro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad Regional de Reumatología y Osteoporosis, Facultad de Medicina y Hospital Central “Dr. Ignacio Morones Prieto,” San Luis Potosí, S.L.P., Mexico" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital General “20 de Noviembre,” ISSSTE, México, D.F., Mexico" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Inmunología, Facultad de Medicina, UASLP, San Luis Potosí, S.L.P., Mexico" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento del lupus eritematoso severo con rituximab. Un estudio abierto" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-06-16" "fechaAceptado" => "2008-09-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec112124" "palabras" => array:7 [ 0 => "Systemic lupus erythematosus" 1 => "Anti-CD20" 2 => "Lupus nephritis" 3 => "Neuropsychiatric involvement" 4 => "Transverse myelitis" 5 => "Massive pulmonary hemorrhage" 6 => "Immunosuppressive therapy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec112125" "palabras" => array:7 [ 0 => "Lupus eritematoso sistémico" 1 => "Anticuerpo monoclonal" 2 => "Nefropatía lúpica" 3 => "Manifestaciones neuropsiquiátricas" 4 => "Mielitis transversa" 5 => "Hemorragia pulmonar masiva" 6 => "Terapia inmunosupresora" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Systemic lupus erythematosus (SLE) is an autoimmune disease that may be associated to high morbidity and mortality. Disease course is variable and unpredictable and although the prognosis and survival of these patients has dramatically improved, treatment of severe multiorganic organic affection in this condition remains a therapeutic challenge. Since B lymphocytes have an important role in the pathogenesis of SLE, it is expected that the targeting of these cells exerts a significant therapeutic effect in SLE patients with severe multiorganic manifestations. In an open clinical trial, we have explored the therapeutic potential of rituximab (an anti-CD20 monoclonal antibody) administration in SLE patients with severe nephritis (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22) or neuropsychiatric manifestations (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6) or massive pulmonary hemorrhage (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3). In most cases, we observed significant improvement in both clinical and laboratory parameters, with good tolerance and few side effects. Thus, patients with severe lupus nephritis showed improvement in disease activity (MEX-SLEDAI index) with a significant reduction (P<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05), as well as proteinuria in most of them (from 3710<span class="elsevierStyleHsp" style=""></span>g/L to 1786<span class="elsevierStyleHsp" style=""></span>g/L, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05); patients with serious neurologic involvement had complete remission of their manifestations; but those with pulmonary massive hemorrhage did not have any response. Rituximab could have an important therapeutic potential in severe SLE, and that it is necessary to carry out a controlled blinded clinical trial to further support this point</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El lupus eritematoso sistémico es un padecimiento con bases autoinmunes que puede asociarse a elevada morbilidad y mortalidad. El curso es variable e impredecible, y aunque el pronóstico y la supervivencia de los pacientes han mejorado importantemente, la afección multiorgánica puede representar un reto terapéutico. Dado que los linfocitos B tienen un papel protagónico en esta enfermedad, es esperable que como blanco del tratamiento, pueda resultar en un efecto terapéutico significativo en el lupus eritematoso. En este estudio clínico abierto, exploramos el potencial terapéutico de la administración de rituximab (un anticuerpo monoclonal) en pacientes con lupus grave: nefropatía (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>422), manifestaciones neuropsiquiátricas (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6) o hemorragia pulmonar masiva (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3). En la mayoría de los pacientes, observamos mejoría significativa, tanto en los parámetros clínicos como de laboratorio y gabinete, con buena tolerancia y pocos eventos adversos. De tal manera que los pacientes con nefropatía lúpica grave mostraron disminución significativa de la actividad de la enfermedad (MEX-SLEDAI) (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05), también en los niveles de proteinuria (de 3.710<span class="elsevierStyleHsp" style=""></span>g/l a 1.786<span class="elsevierStyleHsp" style=""></span>g/l, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05); los pacientes con afección neurológica grave tuvieron remisión completa de sus manifestaciones, aunque en aquellos con hemorragia pulmonar masiva no observamos respuesta alguna. Rituximab pudiera tener un importante potencial terapéutico en los pacientes con lupus grave; es necesario realizar un estudio clínico doble ciego, controlado a largo plazo, que ratifique nuestros hallazgos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.A. 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Bokarewa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2008" "volumen" => "35" "paginaInicial" => "826" "paginaFinal" => "833" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18398943" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000500000004/v1_201305061557/S2173574309701108/v1_201305061557/en/main.assets" "Apartado" => array:4 [ "identificador" => "17338" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000500000004/v1_201305061557/S2173574309701108/v1_201305061557/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574309701108?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 13 | 18 |
| 2024 October | 22 | 41 | 63 |
| 2024 September | 19 | 21 | 40 |
| 2024 August | 36 | 44 | 80 |
| 2024 July | 24 | 38 | 62 |
| 2024 June | 28 | 34 | 62 |
| 2024 May | 26 | 27 | 53 |
| 2024 April | 24 | 12 | 36 |
| 2024 March | 31 | 38 | 69 |
| 2024 February | 20 | 25 | 45 |
| 2024 January | 13 | 23 | 36 |
| 2023 December | 15 | 24 | 39 |
| 2023 November | 18 | 32 | 50 |
| 2023 October | 18 | 26 | 44 |
| 2023 September | 31 | 37 | 68 |
| 2023 August | 23 | 24 | 47 |
| 2023 July | 19 | 31 | 50 |
| 2023 June | 18 | 20 | 38 |
| 2023 May | 14 | 13 | 27 |
| 2023 April | 11 | 11 | 22 |
| 2023 March | 22 | 33 | 55 |
| 2023 February | 22 | 30 | 52 |
| 2023 January | 19 | 21 | 40 |
| 2022 December | 22 | 33 | 55 |
| 2022 November | 24 | 16 | 40 |
| 2022 October | 32 | 29 | 61 |
| 2022 September | 19 | 41 | 60 |
| 2022 August | 30 | 40 | 70 |
| 2022 July | 27 | 34 | 61 |
| 2022 June | 20 | 40 | 60 |
| 2022 May | 24 | 41 | 65 |
| 2022 April | 34 | 47 | 81 |
| 2022 March | 25 | 29 | 54 |
| 2022 February | 29 | 33 | 62 |
| 2022 January | 22 | 29 | 51 |
| 2021 December | 19 | 43 | 62 |
| 2021 November | 34 | 50 | 84 |
| 2021 October | 79 | 40 | 119 |
| 2021 September | 32 | 41 | 73 |
| 2021 August | 25 | 30 | 55 |
| 2021 July | 23 | 32 | 55 |
| 2021 June | 29 | 38 | 67 |
| 2021 May | 28 | 35 | 63 |
| 2021 April | 61 | 36 | 97 |
| 2021 March | 44 | 31 | 75 |
| 2021 February | 35 | 24 | 59 |
| 2021 January | 28 | 12 | 40 |
| 2020 December | 21 | 14 | 35 |
| 2020 November | 19 | 19 | 38 |
| 2020 October | 26 | 18 | 44 |
| 2020 September | 24 | 19 | 43 |
| 2020 August | 17 | 16 | 33 |
| 2020 July | 15 | 8 | 23 |
| 2020 June | 18 | 19 | 37 |
| 2020 May | 17 | 23 | 40 |
| 2020 April | 7 | 15 | 22 |
| 2020 March | 6 | 8 | 14 |
| 2020 February | 1 | 0 | 1 |
| 2019 May | 1 | 0 | 1 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 2 | 1 | 3 |
| 2018 April | 27 | 12 | 39 |
| 2018 March | 12 | 12 | 24 |
| 2018 February | 4 | 3 | 7 |
| 2018 January | 9 | 4 | 13 |
| 2017 December | 11 | 6 | 17 |
| 2017 November | 12 | 8 | 20 |
| 2017 October | 11 | 10 | 21 |
| 2017 September | 11 | 4 | 15 |
| 2017 August | 7 | 4 | 11 |
| 2017 July | 10 | 10 | 20 |
| 2017 June | 18 | 9 | 27 |
| 2017 May | 22 | 10 | 32 |
| 2017 April | 16 | 2 | 18 |
| 2017 March | 20 | 5 | 25 |
| 2017 February | 14 | 2 | 16 |
| 2017 January | 12 | 2 | 14 |
| 2016 December | 34 | 12 | 46 |
| 2016 November | 24 | 1 | 25 |
| 2016 October | 35 | 12 | 47 |
| 2016 September | 21 | 4 | 25 |
| 2016 August | 19 | 6 | 25 |
| 2016 July | 14 | 8 | 22 |
| 2016 May | 3 | 9 | 12 |
| 2015 December | 6 | 0 | 6 |
| 2015 September | 2 | 0 | 2 |
| 2015 July | 12 | 5 | 17 |
| 2015 June | 18 | 10 | 28 |
| 2015 May | 43 | 18 | 61 |
| 2015 April | 17 | 14 | 31 |
| 2015 March | 21 | 15 | 36 |
| 2015 February | 13 | 22 | 35 |
| 2015 January | 16 | 8 | 24 |
| 2014 December | 16 | 10 | 26 |
| 2014 November | 15 | 18 | 33 |
| 2014 October | 11 | 15 | 26 |
| 2014 September | 6 | 15 | 21 |
| 2014 August | 12 | 18 | 30 |
| 2014 July | 18 | 10 | 28 |
| 2014 June | 16 | 9 | 25 |
| 2014 May | 21 | 17 | 38 |
| 2014 April | 24 | 13 | 37 |
| 2014 March | 18 | 25 | 43 |
| 2014 February | 13 | 21 | 34 |
| 2014 January | 14 | 17 | 31 |
| 2013 December | 20 | 12 | 32 |
| 2013 November | 10 | 13 | 23 |
| 2013 October | 23 | 18 | 41 |
| 2013 September | 18 | 27 | 45 |
| 2013 August | 12 | 19 | 31 |
| 2013 July | 20 | 16 | 36 |
| 2013 June | 17 | 14 | 31 |
| 2013 May | 9 | 19 | 28 |
| 2013 April | 11 | 20 | 31 |
| 2013 March | 11 | 14 | 25 |
| 2013 February | 13 | 20 | 33 |
| 2013 January | 6 | 19 | 25 |
| 2012 December | 8 | 10 | 18 |
| 2012 November | 5 | 9 | 14 |
| 2012 October | 3 | 7 | 10 |
| 2012 September | 6 | 3 | 9 |
| 2012 May | 1 | 0 | 1 |
| 2012 April | 6 | 0 | 6 |
| 2012 March | 3 | 0 | 3 |
| 2012 February | 1 | 0 | 1 |
| 2012 January | 8 | 0 | 8 |
| 2011 December | 2 | 0 | 2 |
| 2011 November | 6 | 0 | 6 |
| 2011 October | 3 | 0 | 3 |
| 2011 September | 3 | 0 | 3 |
| 2011 August | 1 | 0 | 1 |
| 2011 July | 2 | 0 | 2 |
| 2011 June | 5 | 0 | 5 |
| 2011 May | 2 | 0 | 2 |
| 2011 March | 4 | 0 | 4 |
| 2011 February | 15 | 0 | 15 |
| 2011 January | 18 | 0 | 18 |
| 2010 December | 10 | 0 | 10 |
| 2010 November | 4 | 0 | 4 |
| 2010 October | 6 | 0 | 6 |
| 2010 September | 4 | 0 | 4 |
| 2010 August | 4 | 0 | 4 |
| 2010 July | 4 | 0 | 4 |
| 2010 June | 4 | 0 | 4 |
| 2010 May | 2 | 0 | 2 |
| 2010 April | 8 | 0 | 8 |
| 2010 March | 13 | 0 | 13 |
| 2010 February | 9 | 0 | 9 |
| 2010 January | 15 | 0 | 15 |
| 2009 December | 25 | 0 | 25 |
| 2009 November | 14 | 0 | 14 |
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