Analysis of rituximab’s usage for the treatment of pediatric systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by chronic inflammation that potentially leads to organ damage. Severe manifestations make the management of SLE difficult and challenging. Nonsteroidal antiinflammatory drugs (NSAIDs), antimalarial drugs, glucocorticoids, immunosuppressive and citotoxic agents are the mainstays of treatment. Unfortunately, these agents are related to a vast toxicity. For an amount of patients, these approaches arent enough to achieve disease activity control, especially in those with cytopenia, nephritis and neuropsychiatric lupus. For these cases, Rituximab (RTX) – a chimeric mouse/human monoclonal antibody specific for human CD20 B-cell – has been widely prescribed. It is known that B-cells have a central role in SLE pathogenesis, being precursors of plasma cells production autoantibodies, precipitating inflammation by producing cytokines, activation T-cells by presentation of self-antigens, and regulating T-cells activity via co-stimulatory molecules. Although the clinical trials of RTX in SLE had controversial results, RTX seems to be a valuable option as an off-label drug for refractory patients.