Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
The use of Rituximab (RTX) has been documented via published cohort data from over 20 sites worldwide (1,2) demonstrating its useful role in the treatment of Systemic Lupus Erythematous (SLE). UCLH have been using RTX for SLE since 2000 and have records from the 139 patients treated to date. The aim of this retrospective review of this cohort data to was determine if there are any relatively simple clinical aspects or bio markers that can help the clinician anticipate the likely response to B Cell depletion with Rituximab.
Methods:
Patients in the UCLH cohort are included once they meet ACR criteria for a diagnosis of SLE. During their routine clinic visits they have prospective data collected which was utilised in this review. Patient files were then reviewed to collect the available laboratory results. From this retrospective analysis 139 patients were identified as having received Rituximab, 121 patients were used in the analysis. We excluded 3 patients due to follow up time <6months and 15 due to missing BILAG scores for the times of interest. We compared the responders (defined using BILAG scores – Complete Response (CR) loss of all A’s or Bs; Partial Response (PR) loss of some A’s and B’s but not all, at 6 month follow up) versus Non-Responders (NR) these do not meet criteria for CR/PR, developed a new A or B during 6months follow up or had died. We only analysed the first dose of RTX with response for each patient.
The cohort is described in table 1.
|
Responders |
Non-Responders |
||
|
Complete Responder (n = 52) |
Partial Responder (n=32) |
(n=37) | |
|
Female |
50 (96%) |
28 (87.5%) |
37 (100%) |
|
Age at diagnosis |
26.3 (8-69) |
25.2 (10-59) |
26.9 (8-51) |
|
Age at RTX |
34.4 (16-69) |
33.2 (15-73) |
34.9 (19-57) |
|
Caucasian |
29 (56%) |
11 (34%) |
13 (35%) |
|
Ro |
24 (47%) |
17 (53%) |
24 (64%) |
|
La |
11 (21%) |
5 (16%) |
10 (27%) |
|
Sm |
13 (25%) |
11 (34%) |
11 (30%) |
|
RNP |
23 (45%) |
17 (53%) |
16 (43%) |
|
Fatigue |
15 (29%) |
8 (25%) |
18 (49%) |
|
Raynauds |
9 (17%) |
6 (19%) |
8 (22%) |
|
Photosensitivity |
2 (4%) |
1 (3%) |
1 (3%) |
|
Rash |
31 (60%) |
12 (38%) |
25 (62%) |
|
Alopecia |
10 (19%) |
8 (25%) |
16 (43%) |
|
Oral ulcers |
10 (19%) |
8 (25%) |
10 (27%) |
|
Arthritis |
33 (63%) |
25 (78%) |
31 (84%) |
|
Serositis |
13 (25%) |
9 (28%) |
7 (19%) |
|
Renal |
18 (35%) |
17 (53%) |
15 (41%) |
|
Neurological |
4 (8%) |
3 (9%) |
6 (16%) |
|
Haematological |
12 (23%) |
9 (28%) |
11 (34%) |
|
B Symptoms |
8 (15%) |
6 (19%) |
8 (22%) |
|
Lymphadenopathy |
2 (4%) |
5 (16%) |
2 (6%) |
|
Vasculitis |
9 (17%) |
6 (19%) |
5 (14%) |
|
Sicca Syndrome |
3 (6%) |
1 (3%) |
2 (6%) |
|
Myositis |
1 (2%) |
2 (6%) |
0 |
|
No Steroids and ≥ 1 immunossupressor |
5 (10%) |
0 |
3 (8%) |
|
Steroids |
2 (4%) |
2 (6%) |
2 (6%) |
|
Steroids and 1 immunosuppression |
7 (13%) |
4 (12%) |
6 (16%) |
|
Steroids and >1 immunosuppression |
38 (25%) |
26 (81%) |
26 (70%) |
|
dsDNA pre-treatment |
|||
| mild elevation <5xULN, |
17 (33%) |
6 (19%) | 7 (19%) |
| moderate elevation >5xULN |
14 (27%) |
17 (53%) | 13 (35%) |
| CD19 depletion at 3 months | 38 (73%) | 27 (84%) | 26 (70%) |
Variables including age, sex, ethnicity, age at diagnosis, age at first dose of rituximab, clinical phenotype, ENA, previous medications, C3 levels pre and at 6months, dsDNA levels pre and 6months, CD19 count pre and at 3 months were examined via univariable analysis to determine if there was a statistically significant correlation.
Results:
Alopecia and fatigue presence were inversely correlated with response to treatment (p value 0.014 and 0.023, respectively) however for fatigue this was not maintained in the sub group analysis (comparison between complete responders and non- responders only). In this cohort there were no statistically significant association between response and CD19 depletion, dsDNA or C3 levels pre and post-Rituximab.
Conclusion:
During this retrospective review of the SLE cohort from UCLH we were unable to identify any routine laboratory biomarkers to predict response. In this cohort the only clinical feature was alopecia which was inversely correlated with response.
References:
1. Favas C, Isenberg DA. Nature Rev Rheum 5; 711-6; 2009.
2. Beckwith, H, Lightstone, L. Nephron Clin Pract 2014;128:250–254 Hannah Beckwith Liz Lightstone
To cite this abstract in AMA style:
Mota P, Hennessey A, Ferenkeh-Koroma A, Isenberg DA. Review of SLE Cohort to Identify Predictors of Response to B Cell Depletion in Patients with Active SLE [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/review-of-sle-cohort-to-identify-predictors-of-response-to-b-cell-depletion-in-patients-with-active-sle/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/review-of-sle-cohort-to-identify-predictors-of-response-to-b-cell-depletion-in-patients-with-active-sle/