Zusammenfassung
Wir berichten über 9 Patienten mit therapierefraktärem systemischen Lupus erythematodes (SLE), die wir mit dem chimären monoklonalen Anti-CD20-Antikörper Rituximab behandelten. Führende klinische Manifestation war bei je 3 Patienten eine Lupusnephritis bzw. eine neurologische Beteiligung, je einmal eine Autoimmunthrombozytopenie, eine Hautbeteiligung mit generalisiertem Erythem sowie eine ausgeprägte Allgemeinsymptomatik mit hämatologischen und immunologischen Aktivitätszeichen.
Drei Patienten mit neurologischer Beteiligung verblieben trotz Deeskalation der immunsuppressiven Therapie in Remission. Ein gutes Ansprechen wurde ferner bei 2 Patienten mit Nierenbeteiligung und der Patientin mit Autoimmunthrombozytopenie dokumentiert. Fünf Patienten zeigten eine Verbesserung der Krankheitsaktivität im ECLAM um mindestens 2 Punkte. Unter der Behandlung wurden keine schwerwiegenden Nebenwirkungen beobachten. Ein Patient verstarb während des Nachbeobachtungszeitraumes. Ein kausaler Zusammenhang zur Rituximab-Behandlung bestand nicht.
Die selektive Depletion der B-Lymphozyten in der Behandlung des SLE scheint eine sichere und effektive Behandlungsoption bei verschiedenen Krankheitsausprägungen darzustellen, die es in größeren Studien zu sichern gilt.
Abstract
We present nine cases of systemic lupus erythematosus with refractory disease that we treated with the chimeric monoclonal anti-CD20 antibody rituximab. Three patients had renal disease, three neurological involvement with transverse myelitis and vasculitis of the central nervous system, one thrombocytopenia, one skin involvement with generalized erythema and one patient had constitutional, haematological and immunological symptoms.
Two patients with renal disease, the patient with immune thrombocytopenia and the three patients with neurological disease, who stayed in remission despite a reduction of immunosuppressive therapy, responded particularly well to the therapy. Five of nine patients showed an improvement in ECLAM of at least two points.
During therapy only minor adverse events were observed. One patient died during follow-up which was unrelated to the therapy.
The selective depletion of B-lymphocytes in the therapy of systemic lupus erythematosus seems to be an effective and safe treatment option for different manifestations.
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Die Autoren G. Chehab und M. Schneider wurden als Referenten von der Firma Roche gesponsert. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.
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Chehab, G., Sander, O., Fischer-Betz, R. et al. Anti-CD20-Therapie zur Remissionsinduktion und -erhaltung bei therapierefraktärem systemischen Lupus erythematodes. Z. Rheumatol. 66, 328–336 (2007). https://doi.org/10.1007/s00393-007-0164-6
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DOI: https://doi.org/10.1007/s00393-007-0164-6