TMA secondary to SLE: rituximab improves overall but not renal survival
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Thrombotic microangiopathy (TMA) includes a series of life-threatening disorders. Systemic lupus erythematosus (SLE) is one of the most common acquired causes. To identify predictors of prognosis in patients with TMA secondary to SLE, we conducted a single-center historical study. From January 2013 to June 2016, of 2182 SLE hospitalized patients in the Ren Ji Hospital, a total of 21 consecutive patients with TMA secondary to SLE were identified. The 90-day short-term mortality was 33.3%. The kidney involvement (66.7%) was associated with poor prognosis, while the administration of rituximab (n = 13) was an independent protective factor according to logistic regression analysis. Compared to conventional treatment, i.e., plasma exchange, high-dose glucocorticoids, and intravenous immunoglobulin, the overall survival is significantly higher among patients receiving rituximab add-on (92.2 vs 33.3%, p = 0.0173); however, five out of seven patients with renal involvement in the rituximab group were eventually hemodialysis dependent. Our data indicated that add-on rituximab in the background of conventional therapy may improve the overall but not the renal survival in SLE-TMA patients.
KeywordsRituximab Systemic lupus erythematosus Thrombotic microangiopathy Thrombotic thrombocytopenic purpura
We are grateful for the technical support from colleagues of IT department.
All authors took part in revising the article and approved the final version to be published. S.Y. and T.L. contributed to the conception and design. W.W., K.W., and Z.C. were responsible for collecting the data. F.S. and X.W. performed the analysis and drafted the article.
F.S. and X.W. contributed equally to this article.
This study was supported by the Scientific Research Foundation of Ren Ji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University (2016PWGZR03).
Compliance with ethical standards
Ethics approval and consent to participate
The protocol of this study complied with the recommendations of the Declaration of Helsinki and was approved by the ethics committees of the Ren Ji Hospital. An informed consent for off-label use of rituximab had been obtained from all patients.
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