Rituximab for therapy-refractory systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disorder which can affect every organ. Its etiopathogenesis is not fully understood, but animal models have demonstrated that B lymphocytes play an important role in the pathogenesis of affected organs. Severely ill patients may not respond to conventional immunosuppressive therapies. In such cases therapeutic options such as plasmapheresis, newer experimental therapies, or autologous stem cell therapy are applied with variable success. Especially for severely affected children safe therapeutic options are desperately needed. We report two children with therapy-refractory SLE who responded to rituximab-a genetically engineered monoclonal CD20 antibody. B-cell depletion with rituximab seems to be a promising therapy for refractory SLE. Compared to the severe side effects of immunosuppressive drugs, rituximab appears to be safer and should be considered for children with severe SLE. Controlled studies are needed.