EFFICACY AND SAFETY OF RITUXIMAB IN CONNECTIVE TISSUE DISEASE RELATED INTERSTITIAL LUNG DISEASE

Background: Pulmonary complications of connective tissue disease are being identified more frequently with the advent of more sophisticated radiological investigations. Limited previous studies have suggested Rituximab (RTX), a chimeric monoclonal antibody with activity against CD-20, may benefit connective tissue disease patients with pulmonary complications. We performed a retrospective analysis of the efficacy and safety of RTX in patients attending a tertiary referral centre. Methods: Ten patients treated with RTX for pulmonary complications of CTD in our institution were identified. Baseline demographics, pre- and post-treatment investigations and adverse events were documented. Results: Eight of ten patients had interstitial changes, two had rheumatoid nodules, one of whom had serositis also. Median follow up time-frame was 12.3 months (range: 3 - 27). For the patients with interstitial changes, a statistically significant improvement in pulmonary function was seen, with a median percentage increase of 22.69% (12.5 to 29.9%) in DlCO (% predicted), p=0.028, and a median percentage increase in FVC (% predicted) of 11.05% (4.22 to 25.94%), p=0.018. For the same group, there was a trend towards improvement in CT severity score. For the two patients without ILD, radiological improvement in nodule size and serositis was seen. No patient had a severe adverse reaction to RTX. Conclusions: Treatment with RTX resulted in an objective, measurable improvement in pulmonary function and/or radiological severity for the majority of patients included in the series. This was statistically significant despite the small numbers included. These results indicate a positive response to RTX with few complications of treatment.