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Vol. 5. Issue 4.
Pages 147-152 (July - August 2009)
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Vol. 5. Issue 4.
Pages 147-152 (July - August 2009)
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Treating severe systemic lupus erythematosus with rituximab. An open study
Tratamiento del lupus eritematoso severo con rituximab. Un estudio abierto
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Carlos Abud-Mendozaa,
Corresponding author
c_abud@hotmail.com

Corresponding author.
, Ricardo Moreno-Valdésa, Enrique Cuevas-Ortaa, Antonio Borjasa, Francisco Arandaa, Fedra Irazoqueb, Lilia Andradeb, M. Vigna-Pérezc, R. González-Amaroc
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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Abstract

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=22) or neuropsychiatric manifestations (n=6) or massive pulmonary hemorrhage (n=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<.05), as well as proteinuria in most of them (from 3710g/L to 1786g/L, P<.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

Keywords:
Systemic lupus erythematosus
Anti-CD20
Lupus nephritis
Neuropsychiatric involvement
Transverse myelitis
Massive pulmonary hemorrhage
Immunosuppressive therapy
Resumen

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=422), manifestaciones neuropsiquiátricas (n=6) o hemorragia pulmonar masiva (n=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<0,05), también en los niveles de proteinuria (de 3.710g/l a 1.786g/l, p<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.

Palabras clave:
Lupus eritematoso sistémico
Anticuerpo monoclonal
Nefropatía lúpica
Manifestaciones neuropsiquiátricas
Mielitis transversa
Hemorragia pulmonar masiva
Terapia inmunosupresora
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