Effect of rituximab on long-term damage acquisition in patients with systemic lupus erythematosus

B-cell depletion therapy has been used for over two decades to treat SLE, but there is a lack of studies reporting its impact on damage progression. This study aims to assess the effectiveness of rituximab in slowing damage acquisition.

We selected 380 patients 190 treated with rituximab and 190 controls, based on matched sex and age of onset, with standard immunosuppressive therapies-to compare the damage they developed, assessed by the SLICC/ACR Damage Index (DI). A secondary analysis of 111 patients was conducted to evaluate DI progression.

The majority of patients were female (94.1%) and Caucasian (45.4%). Severe disease manifestations and higher titres of anti-dsDNA antibodies (86 U/ml vs 62 U/ml; P = 0.012) were seen in the rituximab group, in which SLICC/ACR DI was also higher (1.3 vs 0.9; P = 0.02). In the secondary analysis the SLICC/ACR DI mean had no statistical difference between the two groups (0.4 vs 0.6; P = 0.33), but we identified a statistical significance between the two groups regarding their DI progression (58.2% in the control group vs 44.2% in the rituximab).

As an effective B-cell depleting therapy, rituximab is a valid therapeutic option for SLE patients, especially in those with refractory or life-threatening manifestations. While patients treated with rituximab initially had higher damage, their rate of damage progression was slower compared with those receiving standard therapies.