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Letter
Obinutuzumab in patients with Sjogren’s disease immunised against rituximab
  1. Mathilde Pezot,
  2. Gaétane Nocturne,
  3. Rakiba Belkhir,
  4. Julien Henry,
  5. Stephan Pavy,
  6. Raphaèle Seror,
  7. Xavier Mariette,
  8. Samuel Bitoun
  1. Rheumatology Department, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Le Kremlin Bicêtre, France
  1. Correspondence to Dr Samuel Bitoun, Rheumatology Department, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, Université Paris-Saclay, Le Kremlin Bicêtre 94270, France; samuel.bitoun{at}aphp.fr

https://doi.org/10.1136/ard-2023-224999

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    Patients treated with rituximab (RTX) may develop antidrug antibodies (ADAb) leading to inefficacy and infusion reactions,1 more frequently in systemic autoimmune diseases (sAID) than in rheumatoid arthritis.2 In those immunised patients, targeting B-cells with another anti-CD20 molecule is an option. Obinutuzumab (OBZ) is another anti-CD20 antibody used in lymphoproliferative malignancies.3 Few studies reported its efficacy and safety in patients with sAID,4–6 and none reported documented anti-RTX immunisation. Thus, it remains unknown if OBZ can be safe and efficient in patients with ADAb to RTX.

    This retrospective study included consecutive patients with Sjogren’s disease (SjD) and systemic complications, seen between 2019 and 2023 in our tertiary centre, treated with RTX and having developed anti-RTX ADAb. Safety was collected based on patients records that describe all the hospitalisations occurring during the follow-up. Response to OBZ was determined by the physician 6 months after the first infusion. A switch of treatment before 6 months was considered as non-response.

    We included 13 patients (table 1).

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    Table 1

    Main clinical and biological characteristics and tolerance of the 13 patients before and after OBZ

    Anti-RTX ADAb were detected either because of reactions to a new RTX infusion (n=1) or …

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    Footnotes

    • Handling editor Josef S Smolen

    • Twitter @RakibaBelkhir

    • Contributors Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work: MP, GN, RB, JH, SP, RS, XM and SB. Drafting the work or revising it critically for important intellectual content: MP, GN, RB, JH, SP, RS, XM and SB. Final approval of the version to be published: MP, GN, RB, JH, SP, RS, XM and SB. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: MP and SB.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests XM: honorarium from Astra-Zeneca, BMS, Galapagos, GSK, Novartis, Pfizer.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.