Rituximab as the first-line treatment in newly diagnosed systemic lupus erythematosus
ObjectivesRituximab (RTX) has been commonly used for the treatment of patients with severe or refractory systemic lupus erythematosus (SLE), yet real-world data concerning RTX as the first-line treatment in newly diagnosed moderate-to-severe SLE patients is lacking.MethodsWe conducted a retrospectiv...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1599473/full |
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| author | Haiting Wang Haiting Wang Liling Zhao Shaoying Yang Huihua Ding Wanlong Wu Liqin Yu Jiajia Jin Nan Shen Qiong Fu Shuang Ye |
| author_facet | Haiting Wang Haiting Wang Liling Zhao Shaoying Yang Huihua Ding Wanlong Wu Liqin Yu Jiajia Jin Nan Shen Qiong Fu Shuang Ye |
| author_sort | Haiting Wang |
| collection | DOAJ |
| description | ObjectivesRituximab (RTX) has been commonly used for the treatment of patients with severe or refractory systemic lupus erythematosus (SLE), yet real-world data concerning RTX as the first-line treatment in newly diagnosed moderate-to-severe SLE patients is lacking.MethodsWe conducted a retrospective cohort study using a newly diagnosed (<3 months) hospitalized Systemic Lupus Inception Cohort (hSLIC) at our center between April 1, 2013 and September 1, 2022. All patients were followed up for at least 12 months or until death. The cohort included patients on RTX (n = 104) as the first-line treatment and those on conventional immunosuppressants (IS) (n = 154) as comparators. Propensity-score-based inverse probability of treatment weighting (IPTW) was used to minimize possible confounding factors. The primary outcome analyses included attainment of modified lupus low disease activity state (mLLDAS) and remission by 12 months. The secondary outcomes focused on mortality, major flare rates, and the incidence of adverse events of interest, i.e., major infections.ResultsAfter IPTW, 76.0%/50.5% of RTX-treated patients achieved mLLDAS/remission versus 45.8%/9.7% in the conventional IS group during 12 months of follow-up, respectively (p = 0.005 and p < 0.001). The sensitivity analyses with renal or neuropsychiatric lupus removal and timeline breakout (pre- versus post-November 2019) confirmed the robustness of RTX’s efficacy in achieving mLLDAS and remission outcomes. Additionally, the incidence of major infections was similar between the two groups (12.5% vs. 8.4%, p = 0.288).ConclusionsIn patients with newly diagnosed moderate-to-severe SLE, upfront treatment with RTX was associated with improved clinical outcomes compared to conventional immunosuppressive therapy in terms of achieving low disease activity or remission by 12 months. |
| format | Article |
| id | doaj-art-c43e86de566c4d0c8874f1051a6702c7 |
| institution | DOAJ |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj-art-c43e86de566c4d0c8874f1051a6702c72025-08-20T03:21:39ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-06-011610.3389/fimmu.2025.15994731599473Rituximab as the first-line treatment in newly diagnosed systemic lupus erythematosusHaiting Wang0Haiting Wang1Liling Zhao2Shaoying Yang3Huihua Ding4Wanlong Wu5Liqin Yu6Jiajia Jin7Nan Shen8Qiong Fu9Shuang Ye10Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaImmune Regulation Unit, National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH), Bethesda, MD, United StatesDepartment of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaSuzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, ChinaDepartment of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaObjectivesRituximab (RTX) has been commonly used for the treatment of patients with severe or refractory systemic lupus erythematosus (SLE), yet real-world data concerning RTX as the first-line treatment in newly diagnosed moderate-to-severe SLE patients is lacking.MethodsWe conducted a retrospective cohort study using a newly diagnosed (<3 months) hospitalized Systemic Lupus Inception Cohort (hSLIC) at our center between April 1, 2013 and September 1, 2022. All patients were followed up for at least 12 months or until death. The cohort included patients on RTX (n = 104) as the first-line treatment and those on conventional immunosuppressants (IS) (n = 154) as comparators. Propensity-score-based inverse probability of treatment weighting (IPTW) was used to minimize possible confounding factors. The primary outcome analyses included attainment of modified lupus low disease activity state (mLLDAS) and remission by 12 months. The secondary outcomes focused on mortality, major flare rates, and the incidence of adverse events of interest, i.e., major infections.ResultsAfter IPTW, 76.0%/50.5% of RTX-treated patients achieved mLLDAS/remission versus 45.8%/9.7% in the conventional IS group during 12 months of follow-up, respectively (p = 0.005 and p < 0.001). The sensitivity analyses with renal or neuropsychiatric lupus removal and timeline breakout (pre- versus post-November 2019) confirmed the robustness of RTX’s efficacy in achieving mLLDAS and remission outcomes. Additionally, the incidence of major infections was similar between the two groups (12.5% vs. 8.4%, p = 0.288).ConclusionsIn patients with newly diagnosed moderate-to-severe SLE, upfront treatment with RTX was associated with improved clinical outcomes compared to conventional immunosuppressive therapy in terms of achieving low disease activity or remission by 12 months.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1599473/fullsystemic lupus erythematosusrituximabnewly diagnoseddisease activityB cell |
| spellingShingle | Haiting Wang Haiting Wang Liling Zhao Shaoying Yang Huihua Ding Wanlong Wu Liqin Yu Jiajia Jin Nan Shen Qiong Fu Shuang Ye Rituximab as the first-line treatment in newly diagnosed systemic lupus erythematosus Frontiers in Immunology systemic lupus erythematosus rituximab newly diagnosed disease activity B cell |
| title | Rituximab as the first-line treatment in newly diagnosed systemic lupus erythematosus |
| title_full | Rituximab as the first-line treatment in newly diagnosed systemic lupus erythematosus |
| title_fullStr | Rituximab as the first-line treatment in newly diagnosed systemic lupus erythematosus |
| title_full_unstemmed | Rituximab as the first-line treatment in newly diagnosed systemic lupus erythematosus |
| title_short | Rituximab as the first-line treatment in newly diagnosed systemic lupus erythematosus |
| title_sort | rituximab as the first line treatment in newly diagnosed systemic lupus erythematosus |
| topic | systemic lupus erythematosus rituximab newly diagnosed disease activity B cell |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1599473/full |
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