Pazzola Giulia, Muratore Francesco, Pipitone Nicolò, Crescentini Filippo, Cacoub Patrice, Boiardi Luigi, Spaggiari Lucia, Comarmond Cloe, Croci Stefania, Saadoun David, Salvarani Carlo
Rheumatology Unit, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
Università di Modena e Reggio Emilia, Italy.
Rheumatology (Oxford). 2018 Jul 1;57(7):1151-1155. doi: 10.1093/rheumatology/kex249.
To assess the efficacy and safety of rituximab (RTX) in patients with Takayasu arteritis (TAK).
We conducted a retrospective study on seven TAK patients treated with RTX. Six of the seven patients had a disease refractory to high dose glucocorticoids and conventional immunosuppressive and/or biologic agents. One newly diagnosed, treatment-naïve TAK patient refused glucocorticoids and received RTX alone. Clinical evaluation, laboratory tests and imaging modalities (CT or MR-angiography, and 18F-fluorodeoxyglucose PET/CT) were performed at first RTX administration and every 6 months thereafter. Disease activity was assessed using the Kerr index. We also performed a literature review using PubMed, Ovid MEDLINE and Cochrane library.
Seven patients (6 females) were included in the study. Mean (s.d.) age was 32.4 (17.3) years. At first RTX administration, all patients had active disease according to the Kerr index (⩾2), and had also evidence of active disease at PET/CT. Despite RTX treatment, four of the seven patients had evidence of persistent disease activity and/or radiographic disease progression during follow-up. Three out of seven patients in whom RTX was employed as rescue therapy achieved complete remission. In the literature review, we identified five papers describing nine patients treated with RTX with good results in eight cases, but short follow-up.
Our data do not support a role for RTX as first line biologic therapy in TAK patients, but it may have a role in some patients as second or third line biologic therapy.
评估利妥昔单抗（RTX）治疗大动脉炎（TAK）患者的疗效和安全性。
我们对7例接受RTX治疗的TAK患者进行了一项回顾性研究。7例患者中有6例对高剂量糖皮质激素及传统免疫抑制剂和/或生物制剂治疗无效。1例新诊断的、未接受过治疗的TAK患者拒绝使用糖皮质激素，仅接受RTX治疗。在首次给予RTX时及之后每6个月进行临床评估、实验室检查和影像学检查（CT或磁共振血管造影，以及18F-氟脱氧葡萄糖PET/CT）。使用克尔指数评估疾病活动度。我们还使用PubMed、Ovid MEDLINE和Cochrane图书馆进行了文献综述。
7例患者（6例女性）纳入研究。平均（标准差）年龄为32.4（17.3）岁。首次给予RTX时，根据克尔指数（⩾2），所有患者均有活动性疾病，PET/CT也显示有活动性疾病证据。尽管接受了RTX治疗，但7例患者中有4例在随访期间有持续性疾病活动和/或影像学疾病进展的证据。7例将RTX用作挽救治疗的患者中有3例实现了完全缓解。在文献综述中，我们找到了5篇描述9例接受RTX治疗患者的论文，其中8例效果良好，但随访时间较短。
我们的数据不支持RTX作为TAK患者一线生物治疗的作用，但在某些患者中它可能作为二线或三线生物治疗发挥作用。
