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Rituximab plus belimumab in non-infectious refractory cryoglobulinemia vasculitis: A pilot study
David Saadoun1, Amine Ghembaza1, Sebastien Riviere2
1Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France; Centre national de références Maladies Autoimmunes et systémiques rares et Centre national de références Maladies Autoinflammatoires, UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France.
Objective:
To report the efficacy of rituximab plus belimumab in patients with refractory cryoglobulinemia vasculitis (CV).
Methods:
Belimumab was administered intravenously at a dose of 10 mg/kg on days 0, 14, 28 and then every month in association with rituximab in 4 patients with refractory CV. Demographic, clinical and laboratory characteristics, treatment modalities and outcomes were recorded.
Results:
All patients had type II IgM Kappa cryoglobulinemia, which was associated with primary Sjögren syndrome (n = 1), hepatitis C virus infection (n = 1), and essential (n = 2). Main manifestations of CV included purpura (n = 4), arthralgia and peripheral neuropathy (n = 3), and glomerulonephritis and skin ulcers (n = 1). In all cases, CV was refractory and/or relapse following rituximab. Intravenous belimumab infusion along with rituximab resulted in rapid clinical response in the four patients. Osteitis and recurrent urinary tract infections occurred in two patients.
Conclusion:
Belimumab along with rituximab showed promising results in refractory patients with CV.
