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EXPERIENCE OF RITUXIMAB USE IN A PATIENT WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS

https://doi.org/10.15690/pf.v9i4.396

Abstract

The article presents a case of early onset and severe systemic form of juvenile idiopathic arthritis refractory to classical immunosuppressive therapy, including pulse therapy with methotrexate and combined therapy with methotrexate and cyclosporine. There is described the successful use of chimeric antibodies to CD20 on B lymphocytes — Rituximab — a dose of 375 mg/m2 of body surface in the form of intravenous infusions of 1 time per week for 4 weeks. The child has got one course of treatment with rituximab. By the 12th week of treatment the extraarticular disease manifestations and acute inflammatory changes in the joints stopped, the range of motion in affected joints significantly increased. 22 weeks later the drug induced the development of clinical and laboratory remission, the duration of which is 2.5 years.

About the Authors

E. I. Alekseeva
I.M. Sechenov First Moscow State Medical University Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


E. V. Mitenko
Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


T. M. Bzarova
Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


S. I. Valieva
Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


R. V. Denisova
Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


T. V. Sleptsova
Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


K. B. Isaeva
Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


E. L. Semykina
I.M. Sechenov First Moscow State Medical University Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


E. G. Chistyakova
I.M. Sechenov First Moscow State Medical University Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


A. N. Fetisova
Scientific Center of Children’s Health, RAMS, Moscow
Russian Federation


References

1. Szer I. S., Kimura Y., Malleson P. N., Southwood T. R. Arthritis in children and Adolescents. Juvenile Idiopathic Arthritis. Oxford University Press. 2006. 456 p.

2. CassidyJ., Petty R. eds. Texbook of paediatric rheumatology, 5th Ed. Elsevier Saunders. 2005.

3. Алексеева Е. И., Литвицкий П. Ф. Ревматоидный артрит. Этиология, патогенез. Клиника. Алгоритмы диагностики и лечения. Москва: Веди. 2007. 359 с.

4. Алексеева Е. И., Шахбазян И. Е. Принципы патогенетической тера пии тяжелых системных вариантов ювенильного ревматоидного артрита. Серия «Аутоиммунные болезни». Москва. 2002; 5: 127.

5. Reiff A., Shaham B., Wood B. P. et al. High dose methotrexate in the treatment of refractory juvenile rheumatoid arthritis. Clin Exp Rheumatol. 1995; 13 (1): 113–118.

6. Hashkes P. J., Laxer R. M. Medical treatment of juvenile idiopathic arthritis. JAMA. 2005; 294 (13): 1671–1684.

7. Tambic-Bukovac L., Malcic I., Prohic A. Personal experience with methotrexate in the treatment of idiopathic juvenile arthritis. Reumatizam. 2002; 49 (1): 20–24.

8. Ravelli A., Viola S., Migliavacca D. et al. The extended oligoarticular subtype is the best predictor of methotrexate efficacy in juvenile idiopathic arthritis. J Pediatr. 1999; 135 (3): 316–320.

9. Бзарова Т. М., Алексеева Е. И., Петеркова В. А. Роль факторов болезни и факторов противоревматической терапии в развитии низкорослости у детей, страдающих ювенильным ревматоидным артритом. Вопросы современной педиатрии. 2006; 5 (5): 13–18.

10. Leandro M. J., Edwards J. C., Cambridge G. Clinical outcome in 22 patients with rheumatoid arthritis treated with B lymphocyte depletion. Ann Rheum Dis. 2002; 61: 883–888.

11. Leandro M. J., Edwards J. C., Cambridge G. et al. An open study of B lymphocyte depletion in systemic lupus erythematosus. Arthritis Rheum. 2002; 46: 2673–2677.

12. Oligino T. J., Dalrymple S. A. Targeting B cells for the treatment of rheumatoid arthritis. Arthritis Res Ther. 2003; 5 (Suppl. 4): 7–11.

13. Edwards J. C., Cambridge G., Abrahams V. M. Do self-perpetuating B lymphocytes drive human autoimmune disease? Immunology. 1999; 97: 188–196.

14. Gause A., Berek C. The role of B cells in the pathogenesis of rheumatoid arthritis: potential implications for treatment. Bio-Drugs. 2001; 15: 73–79.

15. Zhang Z., Bridges S. L. Jr. Pathogenesis of rheumatoid arthritis: role of B lymphocytes. Rheum Dis Clin North Am. 2001; 27: 335–353.

16. Насонов Е. Л. Новые направления терапии ревматоидного арт ри та: перспективы применения моноклональных антител к В лимфо цитам (ритуксимаб). Русский медицинский журнал. 2006; 4 (25): 1–4.

17. Panayi G. S. B cell-directed therapy in rheumatoid arthritis — clinical experience. J Rheumatol. 2005; 73 (Suppl.): 19–24.

18. Edwards J. C. W., Cambridge G Sustained improvement in rheumatoid arthritis following a protocol designed to deplete В lymphocytes. Rheumatology (Oxford). 2001; 40: 205–211.

19. De Vita S., Zaja F., Sacco S. et al. Efficacy of selective В cell blockade in the treatment of rheumatoid arthritis. Arthritis Rheum. 2002; 46: 2029–2033.

20. Kramrn H., Hansen K. E., Gowing E., Bridges A. Successful therapy of rheumatoid arthritis with rituximab. Renewed interest in the role of В ceils in the pathogenesis of rheumatoid arthritis. J. Clin. Rheumatol. 2004: 10: 28–32.

21. Kneitz C., Wilhelm M., Tony H. P. improvement of refractory rheumatoid arthritis after depletion of B cells. Scand J Rheumatol. 2004; 33: 82–86.

22. Cambridge G., Leandro M. J., Edwards J. C. et al. Serologic changes following В lymphocyte depletion therapy for rheumatoid arthritis. Arthritis Rheum. 2003; 48: 2146–2154.

23. Pugh-Bernard A. E., Silverman G. J., Cappione A. J. et al. Regulation of inherently autoreactive VH4–34 B cells in the maintenance of human B cell tolerance. J Clin Invest. 2001, 108: 1061–1070.

24. Edwards C. W., Szczepanski L., Szechinski J. et al. Efficacy of B-celi-Targeted therapy with rituximab in patients with rheumatoid arthritis. New Engl. J. Med. 2005; 350: 2572–2581.

25. Насонов Е. Л. Перспективы применения моноклональных антител к В-лимфоцитам (ритуксимаб) при ревматоидном артрите. Клин. фармакол. терапия. 2006; 1–5: 55–58.

26. Emery P., Fleishmann R., Filipowicz-Sospowska A. et al. for the DANCER Study group. The Efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment. Results of a phase lib randomized, double-blind, placebo-controlled dose-range trial. Arthritis Rheum. 2006; 54: 1390–1400.

27. Martini G., Zulian F. Juvenile idiopathic arthritis: current and future treatment option. Expert Opion. Pharmacother. 2006; 7 (4): 387–399.

28. Алексеева Е. И., Бзарова Т. М., Семикина Е.Л., Акулова С. С. Опыт применения ритуксимаба у больной с системным ювенильным ревматоидным артритом. Вопросы современной педиатрии. 2006; 5 (6): 96–100.

29. Алексеева Е. И., Литвицкий П. Ф. Ювенильный ревматоидный артрит. Этиология. Патогенез. Клиника. Алгоритмы диагностики и лечения: Руководство для врачей, преподавателей, научных сотрудников/под общей редакцией академика РАМН, профессора А. А. Баранова. Москва. 2007. С. 325–339.

30. Алексеева Е. И., Бзарова Т. М., Валиева С. И. и др. Ритуксимаб: новые возможности лечения тяжелого рефрактерного ювенильного артрита. Вопросы современной педиатрии. 2008; 7 (2): 22–30.


Review

For citations:


Alekseeva E.I., Mitenko E.V., Bzarova T.M., Valieva S.I., Denisova R.V., Sleptsova T.V., Isaeva K.B., Semykina E.L., Chistyakova E.G., Fetisova A.N. EXPERIENCE OF RITUXIMAB USE IN A PATIENT WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS. Pediatric pharmacology. 2012;9(4):75-80. (In Russ.) https://doi.org/10.15690/pf.v9i4.396

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