Reynaud Q, Killian M, Robles A, Mounsef F, Camdessanché J-P, Mariat C, Cathébras P
Service de médecine interne, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
Service de médecine interne, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
Rev Med Interne. 2015 Dec;36(12):800-12. doi: 10.1016/j.revmed.2015.06.005. Epub 2015 Aug 28.
Rituximab is a human/murine chimeric monoclonal antibody primarily used for treating non-Hodgkin's B-cell lymphoma. Recently, it has also been used in the treatment of several autoimmune diseases.
We conducted a retrospective analysis of patients treated at least once with rituximab between 2010 and 2013 in a French university hospital, to provide a panoramic view of rituximab use including FDA or off-labels uses, its efficacy and safety.
Eighty-seven patients were included with 20 different indications: cryoglobulinemic vasculitis (16%) and anti-PLA2R idiopathic membranous nephropathy (13%) were the most frequent. Rituximab use was off-labels in 50% of cases. Eleven percent of patients experienced severe adverse events, mostly infections. After rituximab, 17% of patients were in complete response (CR), 41% in partial response (PR), and 39% non-responding (NR). Relapse was observed in 65% (33/51) of responding patients.
Further investigation with randomized controlled trials will provide more insight into the specifics of the role of RTX in the overall management of each disease. Identifying clear objectives and strict outcome measures, associated with long term clinical and biological follow-up would help deciding when, how and in which therapeutic regimen will rituximab most benefit a disease or a patient.
利妥昔单抗是一种人/鼠嵌合单克隆抗体，主要用于治疗非霍奇金B细胞淋巴瘤。最近，它也被用于治疗几种自身免疫性疾病。
我们对2010年至2013年期间在一家法国大学医院至少接受过一次利妥昔单抗治疗的患者进行了回顾性分析，以全面了解利妥昔单抗的使用情况，包括美国食品药品监督管理局（FDA）批准的或未获批准的用途、其疗效和安全性。
纳入了87例患者，有20种不同的适应证：冷球蛋白血症性血管炎（16%）和抗磷脂酶A2受体（anti-PLA2R）特发性膜性肾病（13%）最为常见。50%的病例使用利妥昔单抗属于未获批准的用途。11%的患者发生严重不良事件，主要是感染。使用利妥昔单抗后，17%的患者完全缓解（CR），41%部分缓解（PR），39%无反应（NR）。在有反应的患者中，65%（33/51）出现复发。
通过随机对照试验进行进一步研究将更深入地了解利妥昔单抗在每种疾病整体管理中的具体作用。确定明确的目标和严格的结果测量指标，并进行长期的临床和生物学随访，将有助于确定利妥昔单抗在何时、如何以及何种治疗方案下对疾病或患者最有益。
