Magazine article Clinical Psychiatry News

Rituximab Combo Eases Neuropsychiatric SLE

Magazine article Clinical Psychiatry News

Rituximab Combo Eases Neuropsychiatric SLE

Article excerpt

VIENNA -- B-cell depletion with rituximab led to significant improvements in patients with CNS neuropsychiatric disability associated with systemic lupus erythematosus, according to a preliminary report presented by C. Michael Neuwelt, M.D., at the annual European Congress of Rheumatology.

In his investigation, Dr. Neuwelt, of the University of California, San Francisco, and Stanford University, Palo Alto, studied 22 patients who met American College of Rheumatology criteria for CNS-NPSLE disability.

In addition, at baseline, patients met at least one of three criteria: abnormal brain MRI, severe progression of cognitive impairment as shown by neuropsychological testing, or cerebrospinal fluid pleocytosis with or without intrathecal elevation of IgG synthesis and/or oligoclonal banding.

Among the participants in the single-center study, 12 were treated with rituximab monotherapy, 7 were treated with a combination of rituximab and IV cyclophosphamide (IV-CYC), and 3 patients received plasmapheresis synchronized with IV-CYC and were maintained on rituximab for prolonged B-cell suppression.

After up to 18 months' follow up, 72% of the 19 patients treated with either rituximab alone or in combination with IV-CYC showed improvement. The three patients on triple therapy did not improve and required new therapy regimens.

In addition to monitoring changes on the objective parameters, Dr. Neuwelt measured patient outcomes using several standard SLE disease activity indices.

Dr. Neuwelt emphasized that in at least one case, the patient actually had a disease flare with worsening brain lesions following a switch from her prestudy regimen of IV-CYC to rituximab monotherapy.

In her case, combination IV-CYC and rituximab led to significant improvements over baseline (See MRI images before and after combination therapy, at right).

Further research is needed to determine the best candidates for rituximab mono-therapy and which patients will require combination therapy, said Dr. Neuwelt, who is on the advisory board for Genentech Inc., the manufacturer of rituximab (Rituxan).

However, he did not receive funding from Genentech for his study.

Outcomes from his observational study of 22 patients compared well with earlier, published reports of similar patients treated with IV-CYC with and without plasmapheresis, Dr. Neuwelt explained at the meeting, sponsored by the European League Against Rheumatism. …

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