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Rituximab in the treatment of severe lupus myelopathy

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Abstract

Lupus myelopathy (LM) is a rare but critical condition, and the prognosis is grim for patients with severe initial motor deficits despite aggressive conventional immunosuppressive therapy. In this report, six recent-onset severe LM patients with lower extremity muscle strength less than or equal to grade 3 were treated with rituximab combined with pulse methylprednisolone. Four patients showed complete myelopathy response at 12 months. The safety profile of rituximab was tolerable, with urinary tract infection as the most frequent adverse event. Preliminary data indicated that rituximab could be beneficial in preventing permanent neurological damage in severe LM.

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References

  1. Kovacs B, Lafferty TL, Brent LH, DeHoratius RJ (2000) Transverse mylopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature. Ann Rheum Dis 59:120–124

    Article  PubMed  CAS  Google Scholar 

  2. Frohman EM, Wingerchuk DM (2010) Transverse myelitis. N Engl J Med 363:564–572

    Article  PubMed  CAS  Google Scholar 

  3. Lu X, Gu Y, Wang Y, Chen S, Ye S (2008) Prognostic factors of lupus myelopathy. Lupus 358:676–688

    Google Scholar 

  4. Mok CC, Lau CS, Chan EY, Wong RW (1998) Acute transverse myelopathy in systemic lupus erythematosus: clinical presentation, treatment, and outcome. J Rheumatol 25:467–473

    PubMed  CAS  Google Scholar 

  5. Katsiari CG, Giavri I, Mitsikostas DD, Yiannopoulou KG, Sfikakis PP (2010) Acute transverse myelitis and antiphospholipid antibodies in lupus. No evidence for anticoagulation. Eur J Neurol. doi:10.1111/j.1468-1331

    PubMed  Google Scholar 

  6. Birnbaum J, Petri M, Thompson R, Izbudak I, Kerr D (2009) Distinct subtypes of myelitis in systemic lupus erythematosus. Arthritis Rheum 60:3378–3387

    Article  PubMed  CAS  Google Scholar 

  7. de Seze J, Lanctin C, Lebrun C et al (2005) Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology 65:1950–1953

    Article  PubMed  Google Scholar 

  8. Heinlein AC, Gertner E (2007) Marked inflammation in catastrophic longitudinal myelitis associated with systemic lupus erythematosus. Lupus 16:823–826

    Article  PubMed  CAS  Google Scholar 

  9. Espinosa G, Mendizabal A, Minguez S et al (2010) Transverse myelitis affecting more than 4 spinal segments associated with systemic lupus erythematosus: clinical, immunological, and radiological characteristics of 22 patients. Semin Arthritis Rheum 39:246–256

    Article  PubMed  Google Scholar 

  10. Hauser SL, Waubant E, Arnold DL et al (2008) B-cell depletion with Rituximab in relapsing–remitting multiple sclerosis. N Engl J Med 358:676–678

    Article  PubMed  CAS  Google Scholar 

  11. Tokunaga M, Saito K, Kawabata D et al (2007) Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system. Ann Rheum Dis 66:470–475

    Article  PubMed  CAS  Google Scholar 

  12. Armstrong DJ, McCarron MT, Wright GD (2006) SLE-associated with transverse myelitis successfully treated with Rituximab (anti-CD20 monoclonal antibody). Rheumatol Int 26:771–772

    Article  PubMed  CAS  Google Scholar 

  13. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725

    Article  PubMed  CAS  Google Scholar 

  14. Yee CS, Farewell V, Isenberg DA et al (2006) Revised British Isles lupus assessment group 2004 index: a reliable tool for assessment of systemic lupus erythematosus activity. Arthritis Rheum 54:3300–3305

    Article  PubMed  Google Scholar 

  15. Steeves JD, Lammertse D, Curt A et al (2007) Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures. Spinal Cord 45:206–221

    Article  PubMed  CAS  Google Scholar 

  16. Morganti B, Scivoletto G, Ditunno P, Ditunno JF (2005) Walking index for spinal cord injury (WISCI): criterion validation. Spinal Cord 43:27–33

    Article  PubMed  CAS  Google Scholar 

  17. Ramos-Casals M, Soto MJ, Cuadrado MJ, Khamashta MA (2009) Rituximab in systemic lupus erythematosus: a systematic review of off-label use in 188 cases. Lupus 18:767–776

    Article  PubMed  CAS  Google Scholar 

  18. Terrier B, Amoura Z, Ravaud P et al (2010) Safety and efficacy of rituximab in systemic lupus erythematosus: results from 136 patients from the French autoimmunity and rituximab registry. Arthritis Rheum 62:2458–2466

    Article  PubMed  CAS  Google Scholar 

  19. Merrill JT, Neuwelt CM, Wallace DJ et al (2010) Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum 62:222–233

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

This work was supported by Shanghai Jiao Tong University, SMC scholarship (S.Y.)

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Authors and Affiliations

  1. Department of Rheumatology, Renji Hospital, Shanghai JiaoTong University School of Medicine, 145 Shandong C Rd, Shanghai, 200001, China

    Yan Ye, Yueying Gu & Shuang Ye

  2. Department of Emergency Medicine, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200001, China

    Jie Qian

  3. Department of Rheumatology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, China

    Xiaoqing Chen

Authors
  1. Yan Ye
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  2. Jie Qian
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  3. Yueying Gu
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  4. Xiaoqing Chen
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  5. Shuang Ye
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Corresponding authors

Correspondence to Xiaoqing Chen or Shuang Ye.

Additional information

Yan Ye and Jie Qian contributed equally to this study.

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Ye, Y., Qian, J., Gu, Y. et al. Rituximab in the treatment of severe lupus myelopathy. Clin Rheumatol 30, 981–986 (2011). https://doi.org/10.1007/s10067-011-1714-5

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  • DOI: https://doi.org/10.1007/s10067-011-1714-5

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