Clinical Improvement in Antiphospholipid Syndrome After Rituximab Therapy
Clinical Improvement in Antiphospholipid Syndrome After Rituximab Therapy
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DOI：
10.1097/rhu.0b013e31818f38d4
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发表时间：
2008-12-01
影响因子：
3.4
通讯作者：
D'Cruz, David P.
中科院分区：
文献类型：
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作者：
Adamson, Rosemary;Sangle, Shirish;D'Cruz, David P.
利妥昔单抗是针对B细胞特异性抗原CD 20的嵌合单克隆抗体。它对治疗耐药类风湿性关节炎1有效，其用于耐药系统性红斑狼疮（SLE）的报道令人鼓舞。2鉴于B细胞可能是抗磷脂综合征（APS）发病机制的核心，在耐药APS患者中考虑利妥昔单抗似乎是合理的。事实上，有利妥昔单抗成功治疗APS伴血小板减少症患者的病例报告，3例APS伴SLE 4例和2例利妥昔单抗用于治疗其他疾病的患者，降低了抗心磷脂抗体的滴度。5，6口服抗凝剂是既往发生血栓形成事件的APS的标准治疗方法，许多人主张终生使用高强度华法林，国际标准化比率（INR）为3或3.5。华法林的出血风险是众所周知的，但APS患者血栓形成的风险高于出血。8当INR下降到目标范围以下时，更有可能发生此类血栓形成。然而，APS通常难以维持高强度INR，如1项研究所示，该研究发现仅37%的患者INR测定值在3.0至4.0的目标范围内。8由于这些原因，希望找到一种治疗方法，减少APS中抗凝的需要。我们描述了一名患有原发性抗磷脂综合征的患者，表现为肺栓塞、短暂性脑缺血发作、头痛、疲劳和难以控制内部正常化比率。她有效地耗尽B细胞经历了单克隆抗体，利妥昔单抗治疗后症状改善。
Rituximab is a chimeric monoclonal antibody against the B cell-specific antigen CD20. It is effective for the treatment of resistant rheumatoid arthritis 1 and reports of its use in resistant systemic lupus erythematosus (SLE) are encouraging. 2 Given that B cells may be central to the pathogenesis of antiphospholipid syndrome (APS), it seems reasonable to consider rituximab in resistant APS patients. Indeed, there are case reports of rituximab successfully treating patients with APS with thrombocytopenia, 3 APS associated with SLE 4 and 2 patients where rituximab, prescribed for the treatment of other conditions, has reduced the titer of anticardiolipin antibodies. 5, 6Oral anticoagulation is the standard therapy for APS with previous thrombotic events and many advocate life-long high intensity warfarin at an international normalized ratio (INR) of 3 or 3.5. 7 The bleeding risks of warfarin are well known, but patients with APS are at a higher risk of thrombosis than hemorrhage. 8 Such thromboses are more likely to occur when the INR drops below the target range. However, it is often difficult to maintain a high intensity INR in APS as demonstrated by 1 study that found only 37% of patients’ INR determinations to be within the target range of 3.0 to 4.0. 8 For these reasons, it would be desirable to find a therapy which reduces the need for anticoagulation in APS. We describe a patient with primary antiphospholipid syndrome, manifested by pulmonary embolus, transient ischemic attacks, headaches, fatigue, and difficult control of her internal normalized ratio. She effectively depleted B cells experienced symptomatic improvement after treatment with the monoclonal antibody, rituximab.