Effect of long-term treatment with rituximab on pulmonary function and skin fibrosis in patients with diffuse systemic sclerosis

Clin Exp Rheumatol. Mar-Apr 2012;30(2 Suppl 71):S17-22. Epub 2012 May 29.

Abstract

Objectives: To assess the safety and efficacy of long-term treatment with rituximab (RTX) in patients with systemic sclerosis (SSc).

Methods: Eight patients with SSc-associated interstitial lung disease (ILD) received 4 cycles of RTX and had a follow-up of 2 years. Lung involvement was assessed by pulmonary function tests and chest HRCT. Skin involvement was assessed both clinically and histologically.

Results: We found a linear improvement of lung function and skin thickening over the 2 years of RTX treatment. There was a significant increase of FVC at 2 years compared to baseline (mean ± SEM: 77.13±7.13 vs. 68.13±6.96, respectively, p<0.0001). Similarly, DLco increased significantly at 2 years compared to baseline (mean ± SEM: 63.13±7.65 vs. 52.25±7.32, respectively, p<0.001). Skin thickening, assessed with the MRSS, improved significantly at 2 years compared to baseline (mean ± SEM: 4.87±0.83 vs. 13.5±2.42, respectively, p<0.0001). A reduction in myofibroblast score was seen histologically following RTX treatment.

Conclusions: Our results indicate that long-term treatment with RTX may favourably affect lung function and skin fibrosis in patients with SSc. Larger scale, multicentre, randomised, controlled studies are needed to further explore the efficacy of RTX in SSc.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage*
  • Antibodies, Monoclonal, Murine-Derived / adverse effects
  • Biopsy
  • Drug Administration Schedule
  • Female
  • Fibrosis
  • Greece
  • Humans
  • Immunologic Factors / administration & dosage*
  • Immunologic Factors / adverse effects
  • Linear Models
  • Lung / diagnostic imaging
  • Lung / drug effects*
  • Lung / physiopathology
  • Lung Diseases, Interstitial / diagnosis
  • Lung Diseases, Interstitial / drug therapy*
  • Lung Diseases, Interstitial / etiology
  • Lung Diseases, Interstitial / physiopathology
  • Male
  • Middle Aged
  • Myofibroblasts / drug effects
  • Myofibroblasts / pathology
  • Predictive Value of Tests
  • Respiratory Function Tests
  • Rituximab
  • Scleroderma, Diffuse / complications
  • Scleroderma, Diffuse / diagnosis
  • Scleroderma, Diffuse / drug therapy*
  • Scleroderma, Diffuse / physiopathology
  • Skin / drug effects*
  • Skin / pathology
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Immunologic Factors
  • Rituximab