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- Title
Long-term Outcomes After Rituximab Treatment for Patients With Systemic Sclerosis: Follow-up of the DESIRES Trial With a Focus on Serum Immunoglobulin Levels.
- Authors
Kuzumi, Ai; Ebata, Satoshi; Fukasawa, Takemichi; Matsuda, Kazuki M.; Kotani, Hirohito; Yoshizaki-Ogawa, Asako; Sato, Shinichi; Yoshizaki, Ayumi
- Abstract
This cohort study evaluates the long-term outcomes after rituximab treatment for systemic sclerosis and identifies potential response markers. Key Points: Question: What is the long-term outcome of rituximab treatment for systemic sclerosis, and what are the potential markers of response? Findings: In this cohort study of 29 patients, rituximab was associated with significantly improved skin sclerosis and lung function at a median follow-up of 96 weeks. Decrease in serum IgA and IgM levels was associated with greater improvement in skin sclerosis and lung function, respectively. Meaning: The findings of this study suggest that rituximab treatment may provide long-term benefit for patients with systemic sclerosis, and serum immunoglobulins should be explored as potential response markers. Importance: Rituximab is emerging as a promising therapeutic option for systemic sclerosis (SSc), but its long-term outcomes and response markers are unknown. Objective: To evaluate the long-term outcomes after rituximab treatment for SSc and identify potential response markers. Design, Setting, and Participants: In this single-center cohort study, patients with SSc who continued to receive rituximab after the DESIRES trial were analyzed with a median follow-up of 96 weeks. Among the 43 patients who completed the DESIRES trial, 31 continued to receive rituximab, of which 29 with complete data were included in this study. Exposures: Rituximab treatment. Main Outcomes and Measures: A post hoc analysis of the clinical and laboratory data. Results: In 29 patients with SSc (27 female [93%]; median [IQR] age, 48 [35-45] years), significant improvement in modified Rodnan skin score (MRSS) and percentage of predicted forced vital capacity (FVC%) were observed after 1 (median [IQR] change in MRSS, −7 [−8.5 to −4]; P <.001) and 3 (median [IQR] change in FVC% predicted, 1.85 [0.13-5.68]; P <.001) courses of rituximab, respectively, both of which were sustained during follow-up. High responders (MRSS improvement of ≥9; n = 16) experienced a greater decrease in serum levels of IgG (median [IQR] change in IgG, −125 [−207 to −83] vs 7 [−120 to 43]; P =.008) and IgA (median [IQR] change in IgA, −45 [−96 to −32] vs −11 [−20 to 3]; P <.001) compared with low responders (MRSS improvement of ≤8; n = 13). In particular, decrease in serum IgA levels significantly correlated with the improvement in MRSS (r = 0.64; P <.001). At the last follow-up, low IgM, low IgA, and low IgG was observed in 7, 1, and 1 patient, respectively, of which low IgM was associated with greater improvement in FVC% predicted (median [IQR] change in FVC% predicted, 7.2 [3.8-8.9] vs 3.6 [1.4-6.2]; P =.003). Conclusions and Relevance: In this cohort study, rituximab treatment was associated with significantly improved skin and lung fibrosis in SSc in a long-term follow-up. Decrease in serum immunoglobulins was associated with greater clinical response.
- Publication
JAMA Dermatology, 2023, Vol 159, Issue 4, p374
- ISSN
2168-6068
- Publication type
Article
- DOI
10.1001/jamadermatol.2022.6340