THU0345 EFFECT OF THE LONG-TERM RITUXIMAB TREATMENT ON B-LYMPHOCYTES AND ANTINUCLEAR AUTOANTIBODY LEVEL IN PATIENTS WITH SYSTEMIC SCLEROSIS. (2nd June 2020)

• Record Type: Journal Article
• Authors: Garzanova, L.; Ananyeva, L. P.; Koneva, O.; Desinova, O.; Ovsyannikova, O.; Starovoytova, M.; Glukhova, S.; Cherkasova, M.; Aleksankin, A.
• Is Part Of: Annals of the rheumatic diseases. Volume 79(2020)Supplement 1
• Page Start: 404
• Page End: 404
• Publication Date: 2020-06-02
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2020-eular.2490
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Anti-B-cell therapy is seen as a promising therapeutic option for systemic sclerosis (SSc). The study of antinuclear antibody levels during treatment with rituximab (RTX) in patients (pts) with SSc could have theoretical and practical interest. Objectives: To assess the changes in ANA, anti-topoisomerase-1 (Scl-70) levels and B-lymphocytes (B-lymph) count during RTX therapy during prospective observation. Methods: This prospective study included 88 pts with SSc, 83% of them had interstitial lung disease and 75% had positive Scl-70 autoantibody. The mean age was 47 yrs (17-71), female-73 pts (83%), the diffuse cutaneous subset of the disease had 50 pts (57%). The mean disease duration was 5, 9±4, 8 yrs. The mean follow-up period was 27 months (12-42). The cumulative mean dose of RTX was 2, 9±1, 1grams. All patients received prednisolone at a dose of 11, 7±4, 4 mg, immunosuppressants received 42% of them. Patients were divided into groups depending on the duration of the disease: group 1 (n=33) - up to 3 yrs, group 2 (n=25) - from 3 to 6 yrs, group 3 (n=30) - more than 6 years (6-18yrs). The results are presented in the form of mean values, median, upper and lower quartiles. Results: Parallel to clinical improvement in most patients (96%) we found positive changes in many parameters at the end of the study compared to the baseline. The Rodnan skin score decreased from 11, 21±9, 33 to 6, 19±4, 74 (p<0, 001). The disease activity index (EScSG-AI) decreased from 2, 9±1, 74 to 1, 36±1, 15 (p<0, 001). Forced vital capacity, % predicted, increased from 76, 35±19, 65 to 84, 37±21, 04 (p<0, 001). Diffusing capacity for carbon monoxide, % predicted, increased from 45, 56±17, 72 to 47, 62±16, 96 (p<0, 019). The dose of prednisolone decreased from 11, 7±4, 4 to 9, 2±3, 2 mg (p<0, 001). The absolute number of B-lymph decreased from 0, 224±0, 19 to 0, 0175±0, 058 (p<0, 001). The pts of the group 1 showed the highest values of B-lymph at baseline and level of B-lymph decreased from 0, 326±0, 22 to 0, 008±0, 01 (Δ 0, 318) at the end of the study. In group 2 depletion was less pronounced (from 0, 197±0, 14 to 0, 026±0, 07 (Δ 0, 171) and the lowest depletion was observed in group 3 (from 0, 151±0, 16 to 0, 019±0, 07 (Δ 0, 131), p<0, 001 for all groups. An initially positive ANA was found in 92% of pts (range 1/320-1/1280). During observation, the number of pts with high (1/640-1/1280) ANA titers decreased from 70 to 41 (p<0, 001), and the average level of ANA decreased by 30-40% in all groups. At baseline 63 pts (75%), had positive Scl-70 with equal levels in all groups. At the end of the study level of Scl-70 decreased from 125, 02±89, 12 to 108, 6±86, 89 units/ml (p<0, 007). A negative correlation was found between the duration of the disease and ANA (r = -0, 54; p<0, 003) and Scl-70 (r = -0, 44; p<0, 017). Conclusion: In our study a clinical improvement was shown in most pts at the long-term complex therapy, including RTM. We found a significant decrease in the absolute number of B-lymph, as well as decrease of ANA and Scl-70 levels. Initially pts with a short duration of the disease had a higher level of B-lymph and in these pts depletion was more pronounced, compared to those with a longer duration of the disease. However, the level of Scl-70 and ANA decreased both to those who started RTX therapy at an early stage of the disease (<3yrs) and to those who had a long disease duration. Disclosure of Interests: None declared