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Rituximab as Therapy for Refractory Polymyositis and Dermatomyositis ERIKA H. NOSS, DOROTA L. HAUSNER-SYPEK, and MICHAEL E. WEINBLATT ABSTRACT. We describe response to rituximab treatment of refractory inflammatory myopathy. Three patients with long-standing polymyositis (PM) or dermatomyositis (DM) poorly responsive to prednisone combined with several immunosuppressants were given intravenous rituximab 1000 mg on Days 0 and 14. Prior to rituximab, each had significant proximal weakness with creatine phosphokinase (CPK) elevation to > 3 times the normal upper limit (range 789–3123 U/l). Patients were receiving prednisone plus methotrexate (MTX) or azathioprine. CPK decrease was observed 1 month post-infusion, with normalization of levels averaging 4.6 months (range 2.6–7.7 mo). Muscle strength improved in all, with strength returning to normal in 2. Average daily prednisone dose decreased from 16.7 mg (range 10–20 mg) to 4 mg (range 0–7 mg) after infusion. MTX dose was tapered by 50% in 2 patients. The third patient eventually discontinued all additional therapies. Percentage of CD19+ cells in each were suppressed at 0–1% 5 to 6 months after infusion (normal 5–21%). Elevated CPK with return of clinical symptoms occurred in 2 patients 6 and 10 months post-infusion, requiring rituximab retreatment. CD19+ cells remained suppressed at 1% in one patient, but were almost normal at 4% in the other. The third patient remains disease-free 12 months after initial treatment, even though her CD19+ cells are now normal at 8%. Thus, short-term beneficial effects with rituximab were observed in patients with DM and PM. However, the need for retreatment did not correlate with levels of CD19+ cells. (First Release Mar 15 2006; J Rheumatol 2006;33:1021-6) Key Indexing Terms: MYOSITIS
From the Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, and Harvard University School of Medicine, Boston, Massachusetts; and The Center for Rheumatology, Albany, New York, USA. E.H. Noss, MD, PhD; M.E. Weinblatt, MD, Professor of Medicine, Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard University School of Medicine; D.L. Hausner-Sypek, MD, The Center for Rheumatology. Address reprint requests to Dr. M.E. Weinblatt, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, PPB-B3, 75 Francis Street, Boston, MA 02115, USA. E-mail: mweinblatt@partners.org Accepted for publication December 29, 2005.
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