Rituximab plus cyclophosphamide a new approach for refractory lupus

The combination of rituximab and cyclophosphamide may be useful in patients with severe refractory systemic lupus erythematosus (SLE), according to new findings. To assess the efficacy, serological responses, and predictors of response, 16 patients with severe refractory SLE were treated with four weeks of rituximab plus cyclophosphamide. The authors report that at six months of follow-up there was a significant improvement in disease activity scores (BILAG SLEDAI) and that 13 patients showed clinical improvement (defined as a 50% reduction in the Index score). Disease remission was achieved in nine patients. According to isotype analysis, combination therapy produced preferential decreases of IgG and IgA, but not IgM, prompting the authors to suggest that "cells producing pathogenic autoantibodies are preferentially targeted by the treatment." The authors caution against extrapolating their findings to other SLE patients, and conclude "for patients with severe SLE who have failed to respond to conventional treatment, the combination of rituximab and cyclophosphamide can provide a new therapeutic alternative." Reference...