JUN 08, 2009
The authors describe in this article treatment outcomes of four patients with refractory scleritis or orbital inflammation whom they treated with rituximab infusions. A monoclonal antibody that recognizes CD-20+ B lymphocytes and depletes these cells, rituximab has been demonstrated to be effective for treating rheumatoid arthritis, systemic lupus and granulomatosis with polyangiitis (GPA; formerly Wegener's granulomatosis). The authors hypothesize that rituximab may be particularly effective at treating orbital inflammation and scleritis, as these ocular inflammatory diseases may be associated with rheumatoid arthritis, lupus or GPA.
The four patients presented by the authors all had failed multiple medical therapies before undergoing treatment with rituximab. Three of them received 1 g rituximab intravenously twice, with two weeks between doses; the fourth patient received 375 mg/m2 weekly for four weeks. Each patient showed a reasonable response to rituximab therapy, as manifested by the quieting of their inflammatory disease and ability to taper corticosteroid therapy. The mean effect was a reduction in prednisone dose by approximately 25 mg daily down to a mean dose of 5.8 mg daily. Although these results are encouraging, all four patients required at least some immunosuppressive drug therapy after rituximab infusions, with two patients receiving additional rituximab infusions.
This small case series is most helpful for ocular inflammation specialists who either recommend or manage therapy with immunosuppressive agents. While the authors acknowledge the limitations of their small sample size, rituximab may be helpful in select cases in which other forms of immunosuppressive drugs either have not been tolerated or found to be effective at controlling ocular inflammation. Further study of rituximab in larger numbers of patients over longer periods is required to better determine the therapy's effectiveness for treating ocular inflammatory diseases.
Dr. Thorne has no financial relationships to disclose.