Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies
Objective. Idiopathic inflammatory myopathies (IIM) are heterogeneous autoimmune diseases including dermatomyositis (DM), polymyositis (PM), immune-mediated necrotizing myopathy (IMNM), and anti-synthetase syndrome (ASS). Treatment typically involves high-dose corticosteroids (CCS) and conventional...
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PAGEPress Publications
2025-04-01
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| Series: | Reumatismo |
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| Online Access: | https://www.reumatismo.org/reuma/article/view/1817 |
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| author | Stefano Stano Fabio Cacciapaglia Laura Coladonato Giuseppe Lopalco Florenzo Iannone Marco Fornaro |
| author_facet | Stefano Stano Fabio Cacciapaglia Laura Coladonato Giuseppe Lopalco Florenzo Iannone Marco Fornaro |
| author_sort | Stefano Stano |
| collection | DOAJ |
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Objective. Idiopathic inflammatory myopathies (IIM) are heterogeneous autoimmune diseases including dermatomyositis (DM), polymyositis (PM), immune-mediated necrotizing myopathy (IMNM), and anti-synthetase syndrome (ASS). Treatment typically involves high-dose corticosteroids (CCS) and conventional synthetic disease-modifying antirheumatic drugs (csDMARD). Rituximab (RTX) has shown effectiveness in refractory cases. Our real-life study aimed to assess the safety and effectiveness of RTX treatment in IIM patients.
Methods. We conducted a retrospective study including patients with IIM refractory to both high-dose CCS and csDMARD. Patients were treated with a full RTX dose (2 g every 6 months). Laboratory and clinical data, along with the total improvement score (TIS), were assessed to evaluate RTX effectiveness and safety. Data were analyzed using GraphPad Prism (v. 9.5.1).
Results. A total of 41 patients received the full RTX dose (15 DM, 15 ASS, 5 PM, and 6 IMNM). This treatment regimen significantly reduced daily CCS usage from 15 mg [interquartile range (IQR) 12.5-25 mg] at baseline to 5 mg (IQR 5-5 mg) after 1 year of treatment (p<0.001). Additionally, over 90% of patients achieved at least a minimal TIS at 12 months, which was maintained at 24 months. At 1 year, RTX persistence was 68.3%. Although reductions in serum immunoglobulins (Ig)A and IgM levels were observed, no cases of severe hypogammaglobulinemia (IgG<400 mg/dL) occurred. The most common reason for treatment interruption was adverse skin reaction (6 cases) during RTX infusion, while infections involved most frequently the respiratory tract (5 cases).
Conclusions. RTX demonstrated effectiveness in various subsets of IIMs, often leading to clinical improvement and significantly reducing the CCS dose.
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| format | Article |
| id | doaj-art-73735b04d1b746dd8b0adb5b74cd08f0 |
| institution | OA Journals |
| issn | 0048-7449 2240-2683 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Reumatismo |
| spelling | doaj-art-73735b04d1b746dd8b0adb5b74cd08f02025-08-20T02:16:19ZengPAGEPress PublicationsReumatismo0048-74492240-26832025-04-0110.4081/reumatismo.2025.1817Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathiesStefano Stano0Fabio Cacciapaglia1https://orcid.org/0000-0001-7479-4462Laura Coladonato2Giuseppe Lopalco3https://orcid.org/0000-0003-4524-9566Florenzo Iannone4Marco Fornaro5https://orcid.org/0000-0003-1716-7432Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of BariRheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari; Department of Medicine and Surgery, LUM ‘G. De Gennaro’, CasamassimaRheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of BariRheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of BariRheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of BariRheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Objective. Idiopathic inflammatory myopathies (IIM) are heterogeneous autoimmune diseases including dermatomyositis (DM), polymyositis (PM), immune-mediated necrotizing myopathy (IMNM), and anti-synthetase syndrome (ASS). Treatment typically involves high-dose corticosteroids (CCS) and conventional synthetic disease-modifying antirheumatic drugs (csDMARD). Rituximab (RTX) has shown effectiveness in refractory cases. Our real-life study aimed to assess the safety and effectiveness of RTX treatment in IIM patients. Methods. We conducted a retrospective study including patients with IIM refractory to both high-dose CCS and csDMARD. Patients were treated with a full RTX dose (2 g every 6 months). Laboratory and clinical data, along with the total improvement score (TIS), were assessed to evaluate RTX effectiveness and safety. Data were analyzed using GraphPad Prism (v. 9.5.1). Results. A total of 41 patients received the full RTX dose (15 DM, 15 ASS, 5 PM, and 6 IMNM). This treatment regimen significantly reduced daily CCS usage from 15 mg [interquartile range (IQR) 12.5-25 mg] at baseline to 5 mg (IQR 5-5 mg) after 1 year of treatment (p<0.001). Additionally, over 90% of patients achieved at least a minimal TIS at 12 months, which was maintained at 24 months. At 1 year, RTX persistence was 68.3%. Although reductions in serum immunoglobulins (Ig)A and IgM levels were observed, no cases of severe hypogammaglobulinemia (IgG<400 mg/dL) occurred. The most common reason for treatment interruption was adverse skin reaction (6 cases) during RTX infusion, while infections involved most frequently the respiratory tract (5 cases). Conclusions. RTX demonstrated effectiveness in various subsets of IIMs, often leading to clinical improvement and significantly reducing the CCS dose. https://www.reumatismo.org/reuma/article/view/1817Myositisrituximabsafetyeffectiveness |
| spellingShingle | Stefano Stano Fabio Cacciapaglia Laura Coladonato Giuseppe Lopalco Florenzo Iannone Marco Fornaro Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies Reumatismo Myositis rituximab safety effectiveness |
| title | Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies |
| title_full | Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies |
| title_fullStr | Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies |
| title_full_unstemmed | Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies |
| title_short | Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies |
| title_sort | real life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies |
| topic | Myositis rituximab safety effectiveness |
| url | https://www.reumatismo.org/reuma/article/view/1817 |
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