Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 3:13:971366.
doi: 10.3389/fimmu.2022.971366. eCollection 2022.

Low dose versus standard dose rituximab for the treatment of antiphospholipid syndrome: A pilot study from a tertiary medical center

Yuzhou Gan  1   2 , Xue Zhong  3 , Yawei Zhao  4 , Gongming Li  5 , Hua Ye  1   2 , Chun Li  1   2
Affiliations

Low dose versus standard dose rituximab for the treatment of antiphospholipid syndrome: A pilot study from a tertiary medical center

Yuzhou Gan et al. Front Immunol. .

Abstract

Background: To investigate the therapeutic effects and safety of low-dose and standard-dose rituximab (RTX) in the treatment of antiphospholipid syndrome (APS).

Methods: In this real-world study, we included 22 consecutive patients with APS who received RTX. Standard dose (SD) was defined as an overall dosage of RTX ≥ 1000mg in the induction period, and low dose (LD) was defined as an overall dosage of RTX <1000mg.

Results: Of included patients, 1 patients died, 2 patients withdrew and 19 patients completed 6-month follow-up. Nine patients received SD-RTX and 13 patients received LD-RTX, and elder patients [LD-RTX vs. SD-RTX: (49.1 ± 15.5) vs. (35.8 ± 12.3) years, p = 0.044] and patients with later-onset [LD-RTX vs. SD-RTX: (46.8 ± 16.3) vs. (31.3 ± 13.6) years, p = 0.029] were more frequently included in LD-RTX than SD-RTX. Following 6 month RTX treatment, 8 patients (42.1%) achieved complete remission, 8 patients (42.1%) achieved partial remission and 3 patients (15.8%) showed no remission. The titers of anticardiolipin antibodies [baseline vs. 6 months: 30.8 (10.7, 90) vs. 19.5 (2.45, 69.10) U/L, p = 0.023] and the levels of erythrocyte sedimentation rate [baseline vs. 6 months: 29 (6, 63) vs. '6 (3, 14) mm/h, p = 0.021] exhibited a significantly decrease in all APS patients. Remission rate and titers of anti-β2-glycoprotein I and lupus anticoagulant did not differ significantly between two groups.

Conclusion: RTX might be a safe and effective option for patients with APS, and low dose confers equal efficacy as standard dose. Further cohort studies are needed to confirm our findings.

Keywords: antiphospholipid syndrome; low dose; real-world study; rituximab; standard dose.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the patients with isolated thrombotic APS receiving rituximab therapy. There were 22 patients enrolled, with 13 patients received low dose rituximab (an overall dosage <1000mg) and 9 patients received standard dose rituximab (an overall dosage ≥1000mg). One patient discontinued treatment because of died, 2 patients lost to follow up, and 19 patients complement within 6-month follow up. The remission rate was 80.0% (50.0% CR, 30.0%PR) in the low dose group and 88.9% (33.3% % CR, 55.6%PR) in the standard dose group. CR, complete remission; PR, partial remission; NR, no remission.
Figure 2
Figure 2
Remission rate at 6 months. (A) Cumulative complete remission rate for 6 months after induction therapy between patients with SD-RTX and LD-RTX. (B) Comparison of remission rate between patients with SD-RTX and LD-RTX at 3 months and 6 months. SD-RTX, standard-dose rituximab; LD-RTX, low-dose rituximab; CR, complete remission; PR, partial remission; NR, no remission.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, et al. . EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis (2019) 78(10):1296–304. doi: 10.1136/annrheumdis-2019-215213 - DOI - PMC - PubMed
    1. Sevim E, Willis R, Erkan D. Is there a role for immunosuppression in antiphospholipid syndrome. Hematol Am Soc Hematol Educ Program (2019) 2019(1):426–32. doi: 10.1182/hematology.2019000073 - DOI - PMC - PubMed
    1. Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med (2018) 378(21):2010–21. doi: 10.1056/NEJMra1705454 - DOI - PubMed
    1. Rudnicka D, Oszmiana A, Finch DK, Strickland I, Schofield DJ, Lowe DC, et al. . Rituximab causes a polarization of b cells that augments its therapeutic function in NK-cell-mediated antibody-dependent cellular cytotoxicity. Blood (2013) 121(23):4694–702. doi: 10.1182/blood-2013-02-482570 - DOI - PubMed
    1. Sciascia S, Radin M, Cecchi I, Rubini E, Bazzan M, Roccatello D. Long-term effect of b-cells depletion alone as rescue therapy for severe thrombocytopenia in primary antiphospholipid syndrome. Semin Arthritis Rheum (2019) 48(4):741–4. doi: 10.1016/j.semarthrit.2018.04.001 - DOI - PubMed

Publication types