[Rituximab in pediatric patients with systemic lupus erythematosus]

Systemic lupus erythematosus (SLE) is an autoimmune disease that is more severe in pediatric population than in adults. Biological therapy with anti-CD20 (rituximab) in children with SLE was begun to use only a few years ago, in patients that do not respond to conventional therapy. The aim of this study is to determine the clinical response in pediatric patients with SLE that received treatment with rituximab in a third level hospital.

Eight pediatric patients with SLE treated with rituximab were included. Female gender predominated with six (75%). The age at diagnosis of SLE was a mean of 11.3 ± 1.03 years. The mean time between the onset of symptoms and diagnosis was 4.12 ± 1.01 months, and the application of rituximab was 20.7 ± 6.2 months after diagnosis. The most common diagnostic criteria were: malar erythema, hematologic disease, arthritis and kidney disease. Positive ANA title was found in 62.5% of the patients. The clinical activity index MEX-SLEDAI before rituximab was 11.63 ± 6.8 points. Four patients (50%) died, they had activity index before rituximab of 23 ± 1.7 and the survivors of 12.2 ± 3.2 (p = 0.002). After treatment with rituximab the patients that died had 17.6 ± 8.5 points and the survivors 8 ± 2.1 (p = 0.038). In laboratory findings, only C3 and C4 had a significant change after treatment (p = 0.048 and 0.032).

Rituximab reduces lupus activity index and increases complement levels in children with LES that don't respond to conventional therapy.