Rituximab intervention in management of thrombocytopenia in patients with systemic lupus erythematosus: A single centre experience

Objective: Assessment of the efficacy and safety of rituximab (RTX) in treating thrombocytopenia of systemic lupus erythematosus (SLE) patients unresponsive to conventional treatments, highlighting its potential as an alternative to the expensive intravenous immunoglobulin (IVIG), and investigating the optimal number of RTX cycles for complete remission (CR). Methods: A retrospective analysis was conducted on RTX utilization between 2016 and 2023 at our center. Medical records of SLE patients with thrombocytopenia, resistant to conventional treatments, were reviewed. Results: 26 patients (21 females, five males) aged 52.1 +/- 14.4 years were included. All patients received glucocorticoid (GC) treatment and 12 patients received IVIG before RTX administration. The median number of RTX cycles administered was 2.50 (IQR: 2-6). CR was achieved in 18 patients (69.2%), with 10 (38.5%) attaining CR during the initial treatment cycle. Four patients attained partial remission (PR), and four remained refractory. The median number of cycles needed to achieve CR during follow-up was 1.5 (IQR: 1-3.5). RTX significantly reduced the need for GCs, with only 7.7% of patients receiving prednisolone >5 mg afterward. Additionally, IVIG necessity decreased, with only 19.2% of patients requiring IVIG after completing 6 months of RTX treatment (p < 0.046). The median platelet count significantly increased after RTX treatment (p < 0.001) and the incidence of bleeding decreased from 76.9% to 34.6% after 6 months of RTX treatment, with none classified as life-threatening. No side effects were observed, except for hypogammaglobulinemia in one patient (3.8%). Conclusion: RTX demonstrates efficacy and safety for SLE patients with thrombocytopenia unresponsive to conventional treatments, offering a potential alternative, and reducing reliance on GCs and IVIG.