Department of Rheumatology & Immunology, Beijing Key Laboratory for Rheumatism and Immune Diagnosis (BZ0135), Peking University People's Hospital, Beijing, China.
Center of Clinical Immunology, Peking University, Beijing, China.
Front Immunol. 2022 Nov 3;13:971366. doi: 10.3389/fimmu.2022.971366. eCollection 2022.
To investigate the therapeutic effects and safety of low-dose and standard-dose rituximab (RTX) in the treatment of antiphospholipid syndrome (APS).
In this real-world study, we included 22 consecutive patients with APS who received RTX. Standard dose (SD) was defined as an overall dosage of RTX ≥ 1000mg in the induction period, and low dose (LD) was defined as an overall dosage of RTX <1000mg.
Of included patients, 1 patients died, 2 patients withdrew and 19 patients completed 6-month follow-up. Nine patients received SD-RTX and 13 patients received LD-RTX, and elder patients [LD-RTX vs. SD-RTX: (49.1 ± 15.5) vs. (35.8 ± 12.3) years, = 0.044] and patients with later-onset [LD-RTX vs. SD-RTX: (46.8 ± 16.3) vs. (31.3 ± 13.6) years, = 0.029] were more frequently included in LD-RTX than SD-RTX. Following 6 month RTX treatment, 8 patients (42.1%) achieved complete remission, 8 patients (42.1%) achieved partial remission and 3 patients (15.8%) showed no remission. The titers of anticardiolipin antibodies [baseline vs. 6 months: 30.8 (10.7, 90) vs. 19.5 (2.45, 69.10) U/L, = 0.023] and the levels of erythrocyte sedimentation rate [baseline vs. 6 months: 29 (6, 63) vs. '6 (3, 14) mm/h, = 0.021] exhibited a significantly decrease in all APS patients. Remission rate and titers of anti-β2-glycoprotein I and lupus anticoagulant did not differ significantly between two groups.
RTX might be a safe and effective option for patients with APS, and low dose confers equal efficacy as standard dose. Further cohort studies are needed to confirm our findings.
探讨低剂量和标准剂量利妥昔单抗（RTX）治疗抗磷脂综合征（APS）的疗效和安全性。
本真实世界研究纳入了 22 例接受 RTX 治疗的 APS 患者。标准剂量（SD）定义为诱导期 RTX 总量≥1000mg，低剂量（LD）定义为 RTX 总量<1000mg。
纳入的患者中，1 例死亡，2 例退出，19 例完成 6 个月随访。9 例患者接受 SD-RTX，13 例患者接受 LD-RTX，老年患者[LD-RTX 比 SD-RTX：（49.1±15.5）岁比（35.8±12.3）岁，=0.044]和晚发性患者[LD-RTX 比 SD-RTX：（46.8±16.3）岁比（31.3±13.6）岁，=0.029]更倾向于接受 LD-RTX 治疗而非 SD-RTX。经过 6 个月 RTX 治疗后，8 例（42.1%）患者达到完全缓解，8 例（42.1%）患者达到部分缓解，3 例（15.8%）患者无缓解。抗心磷脂抗体滴度[基线比 6 个月：30.8（10.7，90）比 19.5（2.45，69.10）U/L，=0.023]和红细胞沉降率[基线比 6 个月：29（6，63）比 6（3，14）mm/h，=0.021]均显著下降。两组间缓解率及抗β2-糖蛋白 I 和狼疮抗凝物滴度无显著差异。
RTX 可能是 APS 患者安全有效的治疗选择，低剂量与标准剂量疗效相当。需要进一步的队列研究来证实我们的发现。
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