Session Type: Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: The clinical manifestations of the antiphospholipid syndrome (APS) are heterogeneous and related to anti-phospholipid antibodies (aPL). There is some evidence that B cells are involved in the pathogenesis of this condition. Thus the ability of rituximab (RTX) to deplete B cells makes it an appealing potential therapy for refractory antiphospholipid syndrome (APS). Real world data on RTX treatment of APS is still lacking. This study was conducted to report outcomes of RTX administration in the treatment of different aspects of APS.
Methods: This is a retrospective case series study on APS patients from 3 medical centers in Israel who were treated with RTX during 2010-2019 for refractory manifestations of APS including diffuse alveolar hemorrhage, recurrent thrombosis, thrombocytopenia, neurological and skin manifestations. Medical records were reviewed regarding the clinical indication for RTX treatment, concomitant medications, RTX protocol, aPL status and response to treatment. Outcomes were defined as complete response if full resolution of the “indicated manifestation” was achieved and maintained for at least 12 months, partial response or no response
Results: We identified 40 patients who were treated with RTX for refractory APS, 31 patients had primary APS (78%), 24 (60%) were female, mean age was 40 years. A favorable response to RTX was documented in 32 patients (80%) including complete response in 22 (55%). A RTX regimen of 375mg/m2 X 4 was more effective than a regimen of 1000 mgx2 (100% vs. 65%; p=0.01).
Complete response was associated with a decrease in aPL titers 4-6 months post treatment. No significant change in aPL titers was observed in patients with partial or no response.
Conclusion: Consistent with previous small case series, we report a good therapeutic response to RTX in patients with difficult to treat manifestations of APS. In this cohort, treatment protocols were associated with outcomes. Although further studies are required to verify our observations, our data support a plausible role for B cell depletion in refractory APS.
To cite this abstract in AMA style:Agmon-Levin N, Berman M, Harel L, Lidar M, Hajyahia S, Paran D. Rituximab for Refractory Manifestations of the Antiphospholipid Syndrome: A Multicenter Israeli Experience [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/rituximab-for-refractory-manifestations-of-the-antiphospholipid-syndrome-a-multicenter-israeli-experience/. Accessed December 2, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rituximab-for-refractory-manifestations-of-the-antiphospholipid-syndrome-a-multicenter-israeli-experience/