Favorable rituximab response in patients with refractory idiopathic inflammatory myopathies
Abstract Background Interpretation of rituximab efficacy for refractory idiopathic inflammatory myopathies (IIM) is hampered by the absence of a uniform definition of refractory myositis and clinical response. Therefore, rigorous criteria of refractoriness, together with a homogenous definition of c...
Main Authors: | , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2018-09-01
|
Series: | Advances in Rheumatology |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s42358-018-0030-z |
id |
doaj-873e90e55daf46428bf8f224cd25d52a |
---|---|
record_format |
Article |
spelling |
doaj-873e90e55daf46428bf8f224cd25d52a2020-11-25T02:42:36ZengBMCAdvances in Rheumatology2523-31062018-09-015811610.1186/s42358-018-0030-zFavorable rituximab response in patients with refractory idiopathic inflammatory myopathiesFernando Henrique Carlos de Souza0Renata Miossi1Júlio Cesar Bertacini de Moraes2Eloisa Bonfá3Samuel Katsuyuki Shinjo4Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao PauloDivision of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao PauloDivision of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao PauloDivision of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao PauloDivision of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao PauloAbstract Background Interpretation of rituximab efficacy for refractory idiopathic inflammatory myopathies (IIM) is hampered by the absence of a uniform definition of refractory myositis and clinical response. Therefore, rigorous criteria of refractoriness, together with a homogenous definition of clinical improvement, were used to evaluate rituximab one-year response. Methods A retrospective cohort study including 43 IIM (15 antisynthetase syndrome, 16 dermatomyositis, 12 polymyositis) was conducted. All patients had refractory disease (inadequate response to at least two immunosuppressives/immunomodulatories and no less than three months sequentially or concomitantly glucocorticoid tapering) criteria. Clinical/laboratory improvement at one-year was based on modified International Myositis Assessment & Clinical Studies Group (IMACS) core set measures. The patients received two infusions of rituximab (1 g each) at baseline, followed by repeated dose after 6 months. Baseline immunosuppressive therapy was maintained and glucocorticoid dose was tapered according to clinical/laboratory parameters. Results Five patients had side effects at the first rituximab application and were excluded. Therefore, 38 out of 43 patients completed the one-year follow up. Almost 75% of the patients attained clinical and laboratory response after one-year. A significant reduction in median glucocorticoid dose (18.8 vs. 6.3 mg/day) was achieved and 42% patients were able to discontinue prednisone. In contrast, young individuals and patients with dysphagia had a tendency to be non-responders to rituximab. No severe infections were observed. Conclusion This study provides convincing evidence that rituximab is an effective and safe therapy for refractory IIM.http://link.springer.com/article/10.1186/s42358-018-0030-zAntibodiesDermatomyositisMyositisPolymyositisRituximab |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Fernando Henrique Carlos de Souza Renata Miossi Júlio Cesar Bertacini de Moraes Eloisa Bonfá Samuel Katsuyuki Shinjo |
spellingShingle |
Fernando Henrique Carlos de Souza Renata Miossi Júlio Cesar Bertacini de Moraes Eloisa Bonfá Samuel Katsuyuki Shinjo Favorable rituximab response in patients with refractory idiopathic inflammatory myopathies Advances in Rheumatology Antibodies Dermatomyositis Myositis Polymyositis Rituximab |
author_facet |
Fernando Henrique Carlos de Souza Renata Miossi Júlio Cesar Bertacini de Moraes Eloisa Bonfá Samuel Katsuyuki Shinjo |
author_sort |
Fernando Henrique Carlos de Souza |
title |
Favorable rituximab response in patients with refractory idiopathic inflammatory myopathies |
title_short |
Favorable rituximab response in patients with refractory idiopathic inflammatory myopathies |
title_full |
Favorable rituximab response in patients with refractory idiopathic inflammatory myopathies |
title_fullStr |
Favorable rituximab response in patients with refractory idiopathic inflammatory myopathies |
title_full_unstemmed |
Favorable rituximab response in patients with refractory idiopathic inflammatory myopathies |
title_sort |
favorable rituximab response in patients with refractory idiopathic inflammatory myopathies |
publisher |
BMC |
series |
Advances in Rheumatology |
issn |
2523-3106 |
publishDate |
2018-09-01 |
description |
Abstract Background Interpretation of rituximab efficacy for refractory idiopathic inflammatory myopathies (IIM) is hampered by the absence of a uniform definition of refractory myositis and clinical response. Therefore, rigorous criteria of refractoriness, together with a homogenous definition of clinical improvement, were used to evaluate rituximab one-year response. Methods A retrospective cohort study including 43 IIM (15 antisynthetase syndrome, 16 dermatomyositis, 12 polymyositis) was conducted. All patients had refractory disease (inadequate response to at least two immunosuppressives/immunomodulatories and no less than three months sequentially or concomitantly glucocorticoid tapering) criteria. Clinical/laboratory improvement at one-year was based on modified International Myositis Assessment & Clinical Studies Group (IMACS) core set measures. The patients received two infusions of rituximab (1 g each) at baseline, followed by repeated dose after 6 months. Baseline immunosuppressive therapy was maintained and glucocorticoid dose was tapered according to clinical/laboratory parameters. Results Five patients had side effects at the first rituximab application and were excluded. Therefore, 38 out of 43 patients completed the one-year follow up. Almost 75% of the patients attained clinical and laboratory response after one-year. A significant reduction in median glucocorticoid dose (18.8 vs. 6.3 mg/day) was achieved and 42% patients were able to discontinue prednisone. In contrast, young individuals and patients with dysphagia had a tendency to be non-responders to rituximab. No severe infections were observed. Conclusion This study provides convincing evidence that rituximab is an effective and safe therapy for refractory IIM. |
topic |
Antibodies Dermatomyositis Myositis Polymyositis Rituximab |
url |
http://link.springer.com/article/10.1186/s42358-018-0030-z |
work_keys_str_mv |
AT fernandohenriquecarlosdesouza favorablerituximabresponseinpatientswithrefractoryidiopathicinflammatorymyopathies AT renatamiossi favorablerituximabresponseinpatientswithrefractoryidiopathicinflammatorymyopathies AT juliocesarbertacinidemoraes favorablerituximabresponseinpatientswithrefractoryidiopathicinflammatorymyopathies AT eloisabonfa favorablerituximabresponseinpatientswithrefractoryidiopathicinflammatorymyopathies AT samuelkatsuyukishinjo favorablerituximabresponseinpatientswithrefractoryidiopathicinflammatorymyopathies |
_version_ |
1724772686392983552 |