Rituximab therapy for multisystem autoimmune diseases in pediatric patients

To evaluate the effects of rituximab (anti-CD20 monoclonal antibody) on the disease course in pediatric patients with multisystem autoimmune diseases. Four patients with multisystem autoimmune diseases refractory to conventional immunosuppressive medications, each with central nervous system (CNS) i...

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Bibliographic Details
Published in:	The Journal of pediatrics 2003-11, Vol.143 (5), p.598-604
Main Authors:	Binstadt, Bryce A, Caldas, Alvaro M.C, Turvey, Stuart E, Weinstein, Howard J, Jackson, Jean, Fuhlbrigge, Robert C, Sundel, Robert P
Format:	Article
Language:	eng
Subjects:	Adolescent Antibodies - immunology Antibodies, Monoclonal - administration & dosage Antibodies, Monoclonal - therapeutic use Antibodies, Monoclonal, Murine-Derived Antineoplastic Agents - administration & dosage Antineoplastic Agents - therapeutic use Autoimmune Diseases - complications Autoimmune Diseases - immunology Autoimmune Diseases - therapy Bronchitis - complications Child Child, Preschool Female Humans Leukocytosis - complications Leukocytosis - drug therapy Male Neutropenia - complications Neutropenia - drug therapy Peripheral Nervous System Diseases - complications Peripheral Nervous System Diseases - drug therapy Purpura, Thrombocytopenic, Idiopathic - complications Purpura, Thrombocytopenic, Idiopathic - drug therapy Purpura, Thrombocytopenic, Idiopathic - immunology Rituximab Sinusitis - complications
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Summary:	To evaluate the effects of rituximab (anti-CD20 monoclonal antibody) on the disease course in pediatric patients with multisystem autoimmune diseases. Four patients with multisystem autoimmune diseases refractory to conventional immunosuppressive medications, each with central nervous system (CNS) involvement, were treated with four weekly infusions of rituximab. Their clinical and laboratory responses were evaluated. Each of the patients had improvement in clinical symptoms and laboratory parameters. One patient with autoimmune cytopenias and autoimmune CNS and peripheral nervous system disease had resolution of the cytopenias and marked improvement in neurologic symptoms; he currently receives no immunosuppressive medications. Two half-siblings with lymphoplasmacytic colitis, pulmonary nodules, and CNS disease had improvement of their symptoms. A fourth patient with chorea and seizures secondary to primary antiphospholipid antibody syndrome had improvement in fine and gross motor function and reduced seizure frequency. There were no serious adverse events. The biologic response modifier rituximab, designed to eliminate B lymphocytes, was safe and effective in four pediatric patients with multisystem autoimmune disorders. It appears to be beneficial in autoimmune conditions presumably mediated by a variety of B-cell–related mechanisms, and may decrease or eliminate the need for other immunosuppressive medications.
ISSN:	0022-3476 1097-6833