Rituximab treatment for chronic steroid-dependent Henoch-Schonlein purpura: 8 cases and a review of the literature.

Authors:
Courtney B Crayne
Courtney B Crayne
Children's Hospital
Esraa Eloseily
Esraa Eloseily
University of Alabama at Birmingham
Melissa L Mannion
Melissa L Mannion
The University of Alabama at Birmingham
Peter Weiser
Peter Weiser
Washington University School of Medicine
United States
Timothy Beukelman
Timothy Beukelman
University of Alabama at Birmingham
United States
Matthew L Stoll
Matthew L Stoll
University of Alabama at Birmingham
United States
Daniel I Feig
Daniel I Feig
Baylor College of Medicine
Houston | United States

Pediatr Rheumatol Online J 2018 Nov 14;16(1):71. Epub 2018 Nov 14.

Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, 1600 7th Ave S, CPPN G10, Birmingham, AL, 35233, USA.

Background: Henoch-Schonlein purpura (HSP) is a small vessel vasculitis that is characterized by non-thrombocytopenic purpura, abdominal pain, arthritis, and glomerulonephritis. Typically, HSP is self-limited requiring only supportive care, but more severe cases may require corticosteroid (CS) treatment. Rarely, a subset of these patients has persistent rash, arthritis, abdominal involvement, or renal disease despite treatment with CS, or has disease recurrence on CS tapering. Refractory HSP has been effectively treated with a variety of CS sparing therapies. For life-threatening refractory HSP, the B cell depleting agent, rituximab (RTX), has been reported as beneficial for children with substantial renal or central nervous system involvement. However, RTX use for children with less severe HSP, but chronic CS dependent disease refractory to CS sparing immunomodulatory agents, has been less well explored. Herein, we describe 8 children treated with RTX for chronic refractory HSP and report a reduction in recurrent hospitalizations and eventual CS discontinuation.

Methods: This is a retrospective analysis of eight children who were treated with RTX for chronic CS dependent HSP during the years 2006-2014 at a single institution. A chart review of the electronic medical record was performed to determine the presenting symptoms, the type and duration of treatment received, and the number of hospitalizations prior to and after RTX. The number of hospitalizations and oral corticosteroid burden were analyzed using the Wilcoxon signed rank test.

Results: Prior to receiving RTX, seven patients had at least one hospitalization for HSP (median 1.5, range 0-3). Following RTX, only two patients were hospitalized, each a single time for recurrent abdominal pain. The median oral CS burden was 0.345 mg/kg/day before RTX and 0 mg/kg/day at 6 months (p = 0.078), 1 year (p = 0.0625), and 2 years (p = 0.03) following RTX infusion. Seven out of eight children met remission criteria, defined as no active rash, arthritis, nephritis (hematuria and proteinuria), or gastrointestinal distress following RTX. No serious adverse events were noted.

Conclusion: Overall, RTX effectively reduced the number of hospital admissions and oral CS burden. RTX also helped most all children achieve clinical remission. RTX appears to be an effective and safe alternative for chronic CS dependent and immunomodulatory refractory childhood HSP.

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Source
https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-
Publisher Site
http://dx.doi.org/10.1186/s12969-018-0285-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236882PMC
November 2018
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References

(Supplied by CrossRef)
Article in Lancet
FT Saulsbury et al.
Lancet 2007
Article in J Rheumatol
S Bowyer et al.
J Rheumatol 1996
Article in BioDrugs
G Rostoker et al.
BioDrugs 2001
Article in Pediatrics
PF Weiss et al.
Pediatrics 2010
Article in Medicine (Baltimore)
V Calvo-Rio et al.
Medicine (Baltimore) 2016
Article in Pediatr Rheumatol Online J
WT Lei et al.
Pediatr Rheumatol Online J 2018
Article in Arch Dis Child
W Chartapisak et al.
Arch Dis Child 2009
Article in Acta Paediatr
T Lamireau et al.
Acta Paediatr 2001
Article in Clin Pediatr
FT Saulsbury et al.
Clin Pediatr 2009
Article in Pediatr Nephrol
O Jauhola et al.
Pediatr Nephrol 2011
Article in Clin Exp Rheumatol
P Rettig et al.
Clin Exp Rheumatol 2003

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