Background and aims The anti-CD20 agent rituximab (RTX) is generally reserved for the treatment of refractory SLE. Whist response is variable no clear predictors of early response have been confirmed. We aimed to explore factors that predict early response to RTX in a nationwide cohort of patients receiving their first RTX course.
Methods The BILAG-BR has recruited patients with refractory SLE starting RTX in the UK since Sept 2010. For this analysis we included patients who received RTX up to November 2015, had active disease at baseline, and had disease activity indices reported at baseline and 6 months. Response was defined as improvement of all active BILAG 2004 systems with no worsening in other systems or SLEDAI-2K; and no increase in glucocorticoid dose at 6 months.
Results In 197 patients (90.36% females) 99 (50.8%) responded at 6 months. In a multivariable model with imputation for missing variables, concomitant IV cyclophosphamide and higher baseline oral glucocorticoid dose were associated with better response. A higher baseline global BILAG-2004 score was associated with lower rates of response (Table 1).
Conclusions Early response to RTX in refractory SLE was associated with use of concomitant cyclophosphamide, higher glucocorticoid doses and lower baseline disease activity. Serology and demographic factors did not predict response. Understanding how concomitant therapy improves longer-term responses and identifying novel biomarkers of response will improve patient selection and overall outcomes for patients receiving this therapy.
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