期刊
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
卷 204, 期 2, 页码 209-221出版社
AMER THORACIC SOC
DOI: 10.1164/rccm.202009-3481OC
关键词
pulmonary hypertension; systemic sclerosis; treatment
资金
- National Institute of Allergy and Infectious Diseases
- Autoimmunity Centers of Excellence (ACE) collaborative [5U19AI056363]
- Stanford ACE [U19AI110491]
- University of California, San Francisco, ACE [UM1AI110498]
- Colorado ACE [U19AI046374]
- NIH [R01HL095686, R01HL141105, R01HL138473, 5P01HL01495, R01HL082662, NHLBI-HV-10-05, 1U01HL107393-01, PAR-09-185, N01-HV-00242, 1K23HL151892]
- Vera Moulton Wall Center for Pulmonary Vascular Diseases
The study suggested that B-cell depletion therapy may have potential efficacy and safety for SSc-PAH. Low levels of RF, IL-12, and IL-17 may serve as promising predictors of rituximab response. Despite initially showing no significant difference in the primary analysis, the rituximab group demonstrated a statistically significant improvement in 6MWD at Week 24 when considering data through Week 48.
Rationale: Systemic sclerosis (SSc)-pulmonary arterial hypertension (PAH) is one of the most prevalent and deadly forms of PAH. B cells may contribute to SSc pathogenesis. Objectives: We investigated the safety and efficacy of B-cell depletion for SSc-PAH. Methods: In an NIH-sponsored, multicenter, double-blinded, randomized, placebo-controlled, proof-of-concept trial, 57 patients with SSc-PAH on stable-dose standard medical therapy received two infusions of 1,000 mg rituximab or placebo administered 2 weeks apart. The primary outcome measure was the change in 6-minute-walk distance (6MWD) at 24 weeks. Secondary endpoints included safety and invasive hemodynamics. We applied a machine learning approach to predict drug responsiveness. Measurements and Main Results: We randomized 57 subjects from 2010 to 2018. In the primary analysis, using data through Week 24, the adjusted mean change in 6MWD at 24 weeks favored the treatment arm but did not reach statistical significance (23.6 +/- 11.1mvs. 0.5 +/- 9.7 m; P = 0.12). Although a negative study, when data through Week 48 were also considered, the estimated change in 6MWD at Week 24 was 25.5 +/- 8.8 m for rituximab and 0.4 +/- 7.4 m for placebo (P = 0.03). Rituximab treatment appeared to be safe and well tolerated. Low levels of RF (rheumatoid factor), IL-12, and IL-17 were sensitive and specific as favorable predictors of a rituximab response as measured by an improved 6MWD (receiver operating characteristic area under the curve, 0.88-0.95). Conclusions: B-cell depletion therapy is a potentially effective and safe adjuvant treatment for SSc-PAH. Future studies in these patients can confirm whether the identified biomarkers predict rituximab responsiveness.
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