Original Articles
7 April 2025
Early Access
Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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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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Real-life effectiveness of rituximab in different subsets of idiopathic inflammatory myopathies. (2025). Reumatismo. https://doi.org/10.4081/reumatismo.2025.1817
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