Department of Internal Medicine, University of Patras Medical School, Patras, Greece.
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S17-22. Epub 2012 May 29.
To assess the safety and efficacy of long-term treatment with rituximab (RTX) in patients with systemic sclerosis (SSc).
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.
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.
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.
评估利妥昔单抗（RTX）长期治疗系统性硬化症（SSc）患者的安全性和疗效。
8 例 SSc 相关间质性肺病（ILD）患者接受 4 个周期的 RTX 治疗，并随访 2 年。通过肺功能检查和胸部高分辨率 CT（HRCT）评估肺部受累情况。通过临床和组织学评估皮肤受累情况。
我们发现 RTX 治疗 2 年内肺功能和皮肤增厚呈线性改善。与基线相比，2 年时 FVC 显著增加（平均值±SEM：77.13±7.13 比 68.13±6.96，p<0.0001）。同样，DLco 在 2 年内也显著高于基线（平均值±SEM：63.13±7.65 比 52.25±7.32，p<0.001）。用 MRSS 评估的皮肤增厚在 2 年内与基线相比显著改善（平均值±SEM：4.87±0.83 比 13.5±2.42，p<0.0001）。RTX 治疗后组织学上可见肌成纤维细胞评分降低。
我们的结果表明，长期使用 RTX 治疗可能有利于改善 SSc 患者的肺功能和皮肤纤维化。需要更大规模、多中心、随机、对照研究进一步探讨 RTX 在 SSc 中的疗效。
