Severe lupus may respond to drug combo

People with severe lupus that doesn't get better with conventional treatment may be helped with a combination of two potent drugs, Swedish researchers report.

The two drugs are rituximab, known as Rituxan or MabThera, which targets the B cells of the immune system, and cyclophosphamide, a strong immune suppressant drug.

Lupus, technically known as systemic lupus erythematosus or SLE, is an autoimmune disorder that can damage the joints, kidneys, heart, lungs, brain and blood. It is marked sometimes by a characteristic butterfly-shaped rash on the face.

Dr. Ronald F. van Vollenhoven and colleagues at Karolinska University Hospital, Stockholm note in the Annals of the Rheumatic Diseases that B cell depleting therapy with rituxan has "shown encouraging results in patients with SLE."

They studied 16 female patients who had not responded to conventional immunosuppressive therapy and were given weekly infusions of rituximab for 4 weeks. The first and last infusion was combined with cyclophosphamide and a steroid.

After 6 months, there was a significant decrease in a standard measure of SLE severity, and all but three patients showed at least a 50 percent improvement in disease severity.

Furthermore, the disease went into remission in nine of the patients.

The investigators stress that the results should not be generalized to all SLE patients, but conclude that "for patients with severe SLE who have failed to respond to conventional treatment, the combination of rituximab and cyclophosphamide can provide a new therapeutic alternative."

SOURCE: Annals of the Rheumatic Diseases, March 2008.