Rituximab provides new hope for people with lupus

A drug used to treat cancer may also benefit people with lupus who have complications of the central nervous system. Rheumatologists at the Annual European Congress of Rheumatology in Vienna, Austria heard today (Thursday 9 June) that rituximab is the first drug in a quarter of a century that is making a real impact, and an alternative to previous standard treatments of high-dose steroids, and chemotherapy.

Lupus is a disorder of the immune system in which the body attacks itself, causing pain, inflammation and diffuse damage to many organs. In a significant number of cases, the central nervous system is effected which can lead to psychiatric and neurological disturbances. This form of lupus dramatically reduces the quality of life for patients, more so than other manifestations of the disease in which, for example, the kidneys might be affected.

Clinical professor Michael Neuwelt, at the University of California San Francisco and Stanford University, presented results of a trial involving 22 patients over 16 months. "I spent considerable time with oncologists and saw how the drug works in patients with non-Hodgkins lymphoma. Patients with blood disorders of lupus and severe complications of the central nervous system (CNS) also surprisingly improved," he said.

Over half of the patients received rituximab on its own, others received it in combination with steroids, and one-third with the current standard treatment of severe CNS lupus with chemotherapy, cyclophosphamide, combined with rituximab. Rituximab targets a specific type of white blood cells (B cells which make auto-antibodies) and uniquely removes those early B cells before they become harmful. "Rituximab appears to be quite effective. It is a kinder, gentler form of treatment lasting up to six months with a low risk of side-effects, compared to previous treatments of high-dose steroids, and chemo-therapy," said Professor Neuwelt.

There was a significant improvement in 16 of the patients and four others were stabilized. Brain scans demonstrated that the adverse changes that occurred with the disease improved.

Professor Neuwelt specialises in diagnosing and treating patients with CNS lupus. "It can be difficult to disentangle psychiatric disorders that arise from other causes," he states. In a portion of patients, depression, seizures, verbal comprehension, perception and memory will be associated with lupus. People are understandably afraid to admit that their IQ has gone down or that they cannot read any more in fear of losing their job," he continued. A careful history, ruling out other causes such as infection and drug side effects has improved diagnostic accuracy.

Professor Neuwelt, like others using this well-tested oncological drug in other forms of lupus, is concerned about the depletion of the B cells by rituximab for the long term. However, the risk/benefit ratio from this new treatment in its early stages is extremely promising. "It is the first drug in my 26 years of treating patients with severe central nervous system lupus, used alone or in combination with other therapies that has not only significantly boosted the quality of life for patients with this dreadful disease, but also reduced the burden of side effects of standard treatment with steroids and cyclophosphamide. However, we desperately need randomized-controlled trials." he concluded.