Rituximab in systemic sclerosis

Shevtsova T.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

Nadtocheeva V.: Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia

Nimiritskaya S.: Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia

Akulkina L.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

Bulanov N.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

Novikov P.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

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Summary

Aim

To evaluate the effect of intravenous rituximab, a monoclonal antibody to B-cells, on interstitial lung disease, skin fibrosis and arthritis in patients with systemic sclerosis (SSc).

Material and methods

All SSc patients treated with rituximab were enrolled in a retrpospective study. SSc was diagnosed according to ACR-EULAR classification criteria (2013). We evaluated changes in forced vital capacity (FVC, % of predicted), carbon monoxide diffusing capacity (DLCO, % of predicted), DAS-28 ESR/CRP scores, and modified Rodnan skin score (mRSS) at 1 year of treatment and at the end of follow-up.

Results

Rituximab was administered to 14 SSc patients (median age 50.5 years, 12 females). Thirteen patients had interstitial lung disease. All patients were treated previously with glucocorticoids and various immunosuppressive agents, including cyclophosphamide and mycophenolate mofetil. Median FVC remained stable during rituximab treatment, whereas median DLCO increased significantly at the end of follow-up (p=0.004). No patient presented with worsening of lung function parameters. mRRS decreased in 10 patients (71.4%) treated with rituximab and did not change in 4 patients. Median DAS-28/CRP and DAS-28/ESR scores decreased at 1 year of treatment with rituximab (p=0,007 and р=0,017, respectively). Median glucocorticoid dose at 1 year was significantly lower compared to baseline (p=0.043). Prolonged treatment with rituximab (median 2 years, from 1 to 6 years) was well-tolerated. There were no deaths or severe side effects.

Conclusion

Our findings suggest that rituximab may stabilise lung function and improve skin fibrosis in a proportion of patients with SSc who did not respond to previous immunosuppresive treatment.

Key words

Systemic sclerosis, rituximab, interstitial lung disease, skin fibrosis.