Successful Rituximab Treatment of GPIHBP1 Autoantibody-Associated Hypertriglyceridemia

A 50-year-old woman had triglyceride values up to 1640 mg/dL on routine laboratory tests. Despite the initiation of fenofibrate, icosapent ethyl, rosuvastatin, and a low-fat diet, her triglyceride values ranged from 1200 to more than 8200 mg/dL, and she had recurrent pancreatitis.

Testing was negative for mutations in chylomicronemia genes such as LPL, APOC2, APOA5, LMF1, and GPIHBP1. Additional testing revealed elevated autoantibodies to GPIHBP1 up to 2,336 U/mL (normal <58 U/mL) and decreased GPIHBP1 to 2.5 pg/mL (normal range 570-1,625 pg/mL), confirming GPIHBP1 autoantibody syndrome (GPIHBP1-AAS). The patient received rituximab 1000 mg infusion, with 2 doses given 3 weeks apart. Triglycerides decreased from 1,746 to 81 mg/dL within 4 months and remained normal 12 months later without repeat dosing.

GPIHBP1-AAS was only recently described and is associated with severe hypertriglyceridemia and recurrent pancreatitis. In our case, treatment with rituximab was very effective.

GPIHBP1-AAS-associated hypertriglyceridemia should be recognized and can be successfully treated with rituximab.