Tolerance and short term efficacy of rituximab in 43 patients with systemic autoimmune diseases
Identifieur interne : 001E26 ( Main/Exploration ); précédent : 001E25; suivant : 001E27Tolerance and short term efficacy of rituximab in 43 patients with systemic autoimmune diseases
Auteurs : J-E Gottenberg [France] ; L. Guillevin [France] ; O. Lambotte ; B. Combe [France] ; Y. Allanore [France] ; A. Cantagrel [France] ; C. Larroche [France] ; M. Soubrier [France] ; L. Bouillet [France] ; M. Dougados [France] ; O. Fain [France] ; D. Farge [France] ; X. Kyndt [France] ; O. Lortholary [France] ; C. Masson [France] ; B. Moura [France] ; P. Remy [France] ; T. Thomas [France] ; D. Wendling [France] ; J-M Anaya [Colombie] ; J. Sibilia [France] ; X. Mariette [France]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2005-06.
English descriptors
- KwdEn :
- ACR, American College of Rheumatology, ANCA, antineutrophil cytoplasmic antibodies, DAS28, 28 joint disease activity score, MALT, mucosa associated lymphoid tissue, MC, mixed cryoglobulinaemia, RA, rheumatoid arthritis, SLE, systemic lupus erythematosus, SLEDAI, SLE disease activity index, autoimmunity, pSS, primary Sjögren’s syndrome, primary Sjögren’s syndrome, rituximab, systemic lupus erythematosus, systemic vasculitis.
- Teeft :
- Adverse events, Antisynthetase syndrome, Arthritis, Arthritis rheum, Articular, Autoimmune, Autoimmune disease, Autoimmune diseases, Biological data, Blood neutrophil count, Cell depletion, Clinical involvement, Clinical relapse, Complete remission, Concomitant, Corticosteroid, Cryoglobulinaemia, Cyclophosphamide, Daily rheumatological practice, Disease activity index, Erythematosus, Haemolytic anaemia, Hopital, Hopital cochin, Immunosorbent assay, Immunosuppressant, Infusion, Intravenous immunoglobulin, Joint disease activity score, Lupus, Lymphoma, Marketing authorisation, Medecine, Methotrexate, Mycophenolate mofetil, Nephritis, Partial remission, Present study, Primary syndrome, Refractory, Refractory character, Relapse, Remission, Responder, Retrospective study, Rheum, Rheumatoid, Rheumatoid arthritis, Rheumatoid factor, Rheumatology, Rhumatologie, Rituximab, Rituximab treatment, Sarcoidosis, Serum sickness, Short term efficacy, Sledai, Sledai value, Syndrome, Systemic, Systemic lupus erythematosus, Systemic sclerosis, Vasculitis.
Abstract
Objective: To assess the tolerance and efficacy of rituximab in patients with various autoimmune diseases seen in daily rheumatological practice. Methods: 866 rheumatology and internal medicine practitioners were contacted by email to obtain the files of patients treated with rituximab for systemic autoimmune diseases. Patients with lymphoma were analysed if the evolution of the autoimmune disease could be evaluated. Results: In all, 43 of 49 cases could be analysed, including 14 with rheumatoid arthritis (RA), 13 with systemic lupus erythematosus (SLE), six with primary Sjögren’s syndrome (pSS), five with systemic vasculitis, and five with other autoimmune diseases. Rituximab was prescribed for lymphoma in two patients with RA and two with pSS. In the 39 other cases, rituximab was given because of the refractory character of the autoimmune disease. The mean follow up period was 8.3 months (range 2 to 26). There were 11 adverse events in 10 patients and treatment had to be discontinued in six. Efficacy was observed in 30 patients (70%): RA 11, SLE 9, pSS 5, vasculitis 2, antisynthetase syndromes 2, sarcoidosis 1. The mean decrease in corticosteroid intake was 9.5 mg/d (range 0 to 50) in responders. Seven patients experienced relapse after mean 8.1 months (5 to 15). Three patients died because of refractory autoimmune disease. Conclusions: Despite absence of marketing authorisation, rituximab is used to treat various refractory autoimmune diseases in daily rheumatological practice. This study showed good tolerance and short term clinical efficacy, with marked corticosteroid reduction in patients with SLE, pSS, vasculitis, and polymyositis.
Url:
DOI: 10.1136/ard.2004.029694
Affiliations:
- Colombie, France
- Alsace (région administrative), Auvergne (région administrative), Auvergne-Rhône-Alpes, Bourgogne-Franche-Comté, Franche-Comté, Grand Est, Hauts-de-France, Languedoc-Roussillon, Midi-Pyrénées, Nord-Pas-de-Calais, Occitanie (région administrative), Pays de la Loire, Rhône-Alpes, Île-de-France
- Angers, Besançon, Bobigny, Clermont-Ferrand, Créteil, Grenoble, Montpellier, Paris, Saint-Étienne, Strasbourg, Toulouse, Valenciennes
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Guillevin</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Service de Médecine Interne, Hôpital Cochin</wicri:orgArea></affiliation></author><author><name sortKey="Lambotte, O" sort="Lambotte, O" uniqKey="Lambotte O" first="O" last="Lambotte">O. Lambotte</name><affiliation><wicri:noCountry code="subField">Bicêtre</wicri:noCountry></affiliation></author><author><name sortKey="Combe, B" sort="Combe, B" uniqKey="Combe B" first="B" last="Combe">B. Combe</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service d’Immuno-Rhumatologie, Hôpital Lapeyronie, Montpellier</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="Allanore, Y" sort="Allanore, Y" uniqKey="Allanore Y" first="Y" last="Allanore">Y. Allanore</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Service de Rhumatologie A, Hôpital Cochin</wicri:orgArea></affiliation></author><author><name sortKey="Cantagrel, A" sort="Cantagrel, A" uniqKey="Cantagrel A" first="A" last="Cantagrel">A. Cantagrel</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Rhumatologie, Centre Hospitalier Universitaire (CHU), Rangueil, Toulouse</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Midi-Pyrénées</region><settlement type="city">Toulouse</settlement></placeName></affiliation></author><author><name sortKey="Larroche, C" sort="Larroche, C" uniqKey="Larroche C" first="C" last="Larroche">C. Larroche</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Médecine Interne, Hôpital Avicenne, Bobigny</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Bobigny</settlement></placeName></affiliation></author><author><name sortKey="Soubrier, M" sort="Soubrier, M" uniqKey="Soubrier M" first="M" last="Soubrier">M. Soubrier</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation></author><author><name sortKey="Bouillet, L" sort="Bouillet, L" uniqKey="Bouillet L" first="L" last="Bouillet">L. Bouillet</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Médecine Interne, CHU de Grenoble, Grenoble</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Dougados, M" sort="Dougados, M" uniqKey="Dougados M" first="M" last="Dougados">M. Dougados</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Service de Rhumatologie B, Hôpital Cochin</wicri:orgArea></affiliation></author><author><name sortKey="Fain, O" sort="Fain, O" uniqKey="Fain O" first="O" last="Fain">O. Fain</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Médecine Interne, Hôpital Jean Verdier, Bondy</wicri:regionArea><wicri:noRegion>Bondy</wicri:noRegion><wicri:noRegion>Bondy</wicri:noRegion></affiliation></author><author><name sortKey="Farge, D" sort="Farge, D" uniqKey="Farge D" first="D" last="Farge">D. Farge</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Service de Médecine Interne, Hôpital Saint-Louis</wicri:orgArea></affiliation></author><author><name sortKey="Kyndt, X" sort="Kyndt, X" uniqKey="Kyndt X" first="X" last="Kyndt">X. Kyndt</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Nephrologie et Médecine Interne, CHU de Valenciennes, Valenciennes</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Valenciennes</settlement></placeName></affiliation></author><author><name sortKey="Lortholary, O" sort="Lortholary, O" uniqKey="Lortholary O" first="O" last="Lortholary">O. Lortholary</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades</wicri:orgArea></affiliation></author><author><name sortKey="Masson, C" sort="Masson, C" uniqKey="Masson C" first="C" last="Masson">C. Masson</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Rhumatologie, CHU d’Angers, Angers</wicri:regionArea><placeName><region type="region">Pays de la Loire</region><region type="old region">Pays de la Loire</region><settlement type="city">Angers</settlement></placeName></affiliation></author><author><name sortKey="Moura, B" sort="Moura, B" uniqKey="Moura B" first="B" last="Moura">B. Moura</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Rhumatologie, Hôpital Ambroise Paré, Boulogne</wicri:regionArea><wicri:noRegion>Boulogne</wicri:noRegion><wicri:noRegion>Boulogne</wicri:noRegion></affiliation></author><author><name sortKey="Remy, P" sort="Remy, P" uniqKey="Remy P" first="P" last="Remy">P. Remy</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Nephrologie, Hôpital Henri Mondor, Créteil</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Créteil</settlement></placeName></affiliation></author><author><name sortKey="Thomas, T" sort="Thomas, T" uniqKey="Thomas T" first="T" last="Thomas">T. Thomas</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Rhumatologie, CHU Saint-Etienne, Saint-Etienne</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Saint-Étienne</settlement></placeName></affiliation></author><author><name sortKey="Wendling, D" sort="Wendling, D" uniqKey="Wendling D" first="D" last="Wendling">D. Wendling</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Rhumatologie, CHU Jean Minjoz, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Anaya, J M" sort="Anaya, J M" uniqKey="Anaya J" first="J-M" last="Anaya">J-M Anaya</name><affiliation wicri:level="1"><country xml:lang="fr">Colombie</country><wicri:regionArea>Unidad de Reumatología CIB, Universidad Pontificia Bolivariana, Medellin</wicri:regionArea><wicri:noRegion>Medellin</wicri:noRegion></affiliation></author><author><name sortKey="Sibilia, J" sort="Sibilia, J" uniqKey="Sibilia J" first="J" last="Sibilia">J. Sibilia</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Rhumatologie, Hôpital Hautepierre, Strasbourg</wicri:regionArea><placeName><region type="region">Grand Est</region><region type="old region">Alsace (région administrative)</region><settlement type="city">Strasbourg</settlement></placeName></affiliation></author><author><name sortKey="Mariette, X" sort="Mariette, X" uniqKey="Mariette X" first="X" last="Mariette">X. Mariette</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Rhumatologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre</wicri:regionArea><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="ISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2005-06">2005-06</date><biblScope unit="volume">64</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="913">913</biblScope></imprint><idno type="ISSN">0003-4967</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-4967</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ACR, American College of Rheumatology</term><term>ANCA, antineutrophil cytoplasmic antibodies</term><term>DAS28, 28 joint disease activity score</term><term>MALT, mucosa associated lymphoid tissue</term><term>MC, mixed cryoglobulinaemia</term><term>RA, rheumatoid arthritis</term><term>SLE, systemic lupus erythematosus</term><term>SLEDAI, SLE disease activity index</term><term>autoimmunity</term><term>pSS, primary Sjögren’s syndrome</term><term>primary Sjögren’s syndrome</term><term>rituximab</term><term>systemic lupus erythematosus</term><term>systemic vasculitis</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Adverse events</term><term>Antisynthetase syndrome</term><term>Arthritis</term><term>Arthritis rheum</term><term>Articular</term><term>Autoimmune</term><term>Autoimmune disease</term><term>Autoimmune diseases</term><term>Biological data</term><term>Blood neutrophil count</term><term>Cell depletion</term><term>Clinical involvement</term><term>Clinical relapse</term><term>Complete remission</term><term>Concomitant</term><term>Corticosteroid</term><term>Cryoglobulinaemia</term><term>Cyclophosphamide</term><term>Daily rheumatological practice</term><term>Disease activity index</term><term>Erythematosus</term><term>Haemolytic anaemia</term><term>Hopital</term><term>Hopital cochin</term><term>Immunosorbent assay</term><term>Immunosuppressant</term><term>Infusion</term><term>Intravenous immunoglobulin</term><term>Joint disease activity score</term><term>Lupus</term><term>Lymphoma</term><term>Marketing authorisation</term><term>Medecine</term><term>Methotrexate</term><term>Mycophenolate mofetil</term><term>Nephritis</term><term>Partial remission</term><term>Present study</term><term>Primary syndrome</term><term>Refractory</term><term>Refractory character</term><term>Relapse</term><term>Remission</term><term>Responder</term><term>Retrospective study</term><term>Rheum</term><term>Rheumatoid</term><term>Rheumatoid arthritis</term><term>Rheumatoid factor</term><term>Rheumatology</term><term>Rhumatologie</term><term>Rituximab</term><term>Rituximab treatment</term><term>Sarcoidosis</term><term>Serum sickness</term><term>Short term efficacy</term><term>Sledai</term><term>Sledai value</term><term>Syndrome</term><term>Systemic</term><term>Systemic lupus erythematosus</term><term>Systemic sclerosis</term><term>Vasculitis</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective: To assess the tolerance and efficacy of rituximab in patients with various autoimmune diseases seen in daily rheumatological practice. Methods: 866 rheumatology and internal medicine practitioners were contacted by email to obtain the files of patients treated with rituximab for systemic autoimmune diseases. Patients with lymphoma were analysed if the evolution of the autoimmune disease could be evaluated. Results: In all, 43 of 49 cases could be analysed, including 14 with rheumatoid arthritis (RA), 13 with systemic lupus erythematosus (SLE), six with primary Sjögren’s syndrome (pSS), five with systemic vasculitis, and five with other autoimmune diseases. Rituximab was prescribed for lymphoma in two patients with RA and two with pSS. In the 39 other cases, rituximab was given because of the refractory character of the autoimmune disease. The mean follow up period was 8.3 months (range 2 to 26). There were 11 adverse events in 10 patients and treatment had to be discontinued in six. Efficacy was observed in 30 patients (70%): RA 11, SLE 9, pSS 5, vasculitis 2, antisynthetase syndromes 2, sarcoidosis 1. The mean decrease in corticosteroid intake was 9.5 mg/d (range 0 to 50) in responders. Seven patients experienced relapse after mean 8.1 months (5 to 15). Three patients died because of refractory autoimmune disease. Conclusions: Despite absence of marketing authorisation, rituximab is used to treat various refractory autoimmune diseases in daily rheumatological practice. This study showed good tolerance and short term clinical efficacy, with marked corticosteroid reduction in patients with SLE, pSS, vasculitis, and polymyositis.</div></front></TEI><affiliations><list><country><li>Colombie</li><li>France</li></country><region><li>Alsace (région administrative)</li><li>Auvergne (région administrative)</li><li>Auvergne-Rhône-Alpes</li><li>Bourgogne-Franche-Comté</li><li>Franche-Comté</li><li>Grand Est</li><li>Hauts-de-France</li><li>Languedoc-Roussillon</li><li>Midi-Pyrénées</li><li>Nord-Pas-de-Calais</li><li>Occitanie (région administrative)</li><li>Pays de la Loire</li><li>Rhône-Alpes</li><li>Île-de-France</li></region><settlement><li>Angers</li><li>Besançon</li><li>Bobigny</li><li>Clermont-Ferrand</li><li>Créteil</li><li>Grenoble</li><li>Montpellier</li><li>Paris</li><li>Saint-Étienne</li><li>Strasbourg</li><li>Toulouse</li><li>Valenciennes</li></settlement></list><tree><noCountry><name sortKey="Lambotte, O" sort="Lambotte, O" uniqKey="Lambotte O" first="O" last="Lambotte">O. Lambotte</name></noCountry><country name="France"><noRegion><name sortKey="Gottenberg, J E" sort="Gottenberg, J E" uniqKey="Gottenberg J" first="J-E" last="Gottenberg">J-E Gottenberg</name></noRegion><name sortKey="Allanore, Y" sort="Allanore, Y" uniqKey="Allanore Y" first="Y" last="Allanore">Y. Allanore</name><name sortKey="Bouillet, L" sort="Bouillet, L" uniqKey="Bouillet L" first="L" last="Bouillet">L. Bouillet</name><name sortKey="Cantagrel, A" sort="Cantagrel, A" uniqKey="Cantagrel A" first="A" last="Cantagrel">A. Cantagrel</name><name sortKey="Combe, B" sort="Combe, B" uniqKey="Combe B" first="B" last="Combe">B. Combe</name><name sortKey="Dougados, M" sort="Dougados, M" uniqKey="Dougados M" first="M" last="Dougados">M. Dougados</name><name sortKey="Fain, O" sort="Fain, O" uniqKey="Fain O" first="O" last="Fain">O. Fain</name><name sortKey="Farge, D" sort="Farge, D" uniqKey="Farge D" first="D" last="Farge">D. Farge</name><name sortKey="Guillevin, L" sort="Guillevin, L" uniqKey="Guillevin L" first="L" last="Guillevin">L. Guillevin</name><name sortKey="Kyndt, X" sort="Kyndt, X" uniqKey="Kyndt X" first="X" last="Kyndt">X. Kyndt</name><name sortKey="Larroche, C" sort="Larroche, C" uniqKey="Larroche C" first="C" last="Larroche">C. Larroche</name><name sortKey="Lortholary, O" sort="Lortholary, O" uniqKey="Lortholary O" first="O" last="Lortholary">O. Lortholary</name><name sortKey="Mariette, X" sort="Mariette, X" uniqKey="Mariette X" first="X" last="Mariette">X. Mariette</name><name sortKey="Masson, C" sort="Masson, C" uniqKey="Masson C" first="C" last="Masson">C. Masson</name><name sortKey="Moura, B" sort="Moura, B" uniqKey="Moura B" first="B" last="Moura">B. Moura</name><name sortKey="Remy, P" sort="Remy, P" uniqKey="Remy P" first="P" last="Remy">P. Remy</name><name sortKey="Sibilia, J" sort="Sibilia, J" uniqKey="Sibilia J" first="J" last="Sibilia">J. Sibilia</name><name sortKey="Soubrier, M" sort="Soubrier, M" uniqKey="Soubrier M" first="M" last="Soubrier">M. Soubrier</name><name sortKey="Thomas, T" sort="Thomas, T" uniqKey="Thomas T" first="T" last="Thomas">T. Thomas</name><name sortKey="Wendling, D" sort="Wendling, D" uniqKey="Wendling D" first="D" last="Wendling">D. Wendling</name></country><country name="Colombie"><noRegion><name sortKey="Anaya, J M" sort="Anaya, J M" uniqKey="Anaya J" first="J-M" last="Anaya">J-M Anaya</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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