Background and aims Treatment options for SLE have significant morbidity and mortality. Side effects from corticosteroid usage limit patient adherence and treatment efficacy. B cell depletion appears to target a critical pathophysiological pathway in SLE. Trails with rituximab has shown mixed results.

We aim to analyse our experience of using rituximab and mycophenolate upfront on presentation with minimum oral steroids.

Methods 12 patients with SLE, seen between Jan 2015 to march 2016, were included in the study. All patients completed 6 months of follow-up. Patients were treated with 2 doses of rituximab (1 g) and methyl prednisolone (500 mg) on days 1 and 15, and maintenance treatment of mycophenolate mofetil (2000mg) and low dose prednisolone (<7.5 mg) which was tapered off.

Results 10 were females and 2 males. Mean age of the patients is 24.5. 9 had lupus nephritis, 1 mesenteric vasculitis, 1 CNS vasculitis and 1 severe cutaneous vasculitis with pancytopenia. Average SLEDAI improved from 14 to 4. 6/9 LN attained complete renal remission and 2 partial remission. one patient died due to infection and renal disease 15 days after infusion. 2 vasculitis and one NPSLE patient improved completely. Two patients had infection requiring hospitalisation with in 8 weeks of infusion and one patient had severe bradycardia during the infusion and received only 1000 mg rituximab. Steroid was stopped by 6 months in 6 patients and in the dose was below 5 mg in rest.

Conclusions Early Rituximab and mycophenolate is an effective option for treating severe lupus and has steroid sparing property.