36% of patients with refractory systemic lupus erythematosus (SLE or lupus) remain well after undergoing B-cell depletion therapy (BCDT) without needing further standard immunosuppressive agents, according to a study presented at EULAR 2007, the Annual European Congress of Rheumatology in Barcelona, Spain.
Overactive B-cells are commonly found in patients with SLE and reducing the number of B-cells in the system by BCDT has been suggested as a promising therapy for SLE patients who are unresponsive to other treatments.
In this study, initiated in 2000, patients with refractory SLE were treated with BCDT (based on rituximab) using a combination protocol with cyclophosphamide and steroids. Of the 33 patients who had a minimum of 6 months follow-up duration at the time of analysis (mean duration 37 months, range 6-79), 12 patients remained well. Median duration of B-cell depletion was 4 months (range 2-15), with 2 patients remaining depleted at time of analysis (73 and 8 months respectively). B-cell depletion was beneficial clinically, with a decrease of median global BILAG scores (clinical activity index see Editors note) from 13 to 5 when measured between 5 and 8 months p<0.0001).
Autoantibody profiling was also examined during the study as a possible predictor of flare of disease. Patients with low baseline serum C3 (84%) had a shorter time to flare post-BCDT (a lower level is a strong indicator of high levels of disease activity) and patients with anti-ENA antibodies notably anti-Sm antibodies (63%) were more likely to flare at any time after BCDT with an odds ratio (OR) of 6 (p=0.03).