Table 2 Studies of rituximab associated with intravenous Immunoglobulin in several autoimmune conditions
From: Rituximab combined with intravenous immunoglobulin in autoimmune diseases: a systematic review
Author, reference | Study design | Country | N | Age (years old)/gender | Disease | Disease duration | RTX dose (mg/day), IVIg dose | Follow-up | Outcome | Side effects |
|---|---|---|---|---|---|---|---|---|---|---|
Muzaffar et al., 2012 [21]. | Case report | USA | 1 | 65 yo Male | Acquired factor VIII inhibitor | 3 days | IVIg (8 doses)-1 g/kg/day) RTX − 750 mg /m2 – 4 weekly doses. | 4 mo | Patients went into remission with disappearance of acquired factor VIII inhibitor | ND |
Andres et al., 2014 [22]. | Case report | Spain | 1 | 17 yo; Female | Neuromyelitis optica | 5 years | RTX-375 mg/m2 for 2 doses; IVIg- 400 mg/ kg/day for 5 days | 2 years | After 4 months, the neurological examination was normal; improvements in MRI and reduction in anti-aquaporin-4 titers. | None |
Gorson et al., 2015 [23]. | Prospective open-label | USA | 6 | Mean age – 68.2 yo; ND | IVIg-dependent autoimmune polyneuropathy | ND | RTX (375 mg/ m2 /week) for 4 weeks + baseline IVIg. | 1 year | RTX did not reduce IVIg requirements in the majority of patients with IVIg-dependent, immune-mediated polyneuropathies. | None |
Gertner et al., 2016 [24]. | Case report | USA | 1 | 22 yo; male | Susac syndrome | 2 weeks | IVIg- 500 mg/kg – day 1,3 and 4; RTX- 1000 mg – day 2 Maintenance with IVIg, AAS, and azathioprine. | 6 mo | After the first month of treatment, he was able to resume all his daily activities without difficulty or recurrence | ND |
Watson et al., 2017 [25]. | Case report | Australia | 1 | 64 yo Male | Neuropsychiatric systemic Lupus erythematosus | ND | ND | ND | The neuropsychiatric syndrome settled, and the disease activity reduced. | ND. |
Oktem et al., 2017 [26]. | Case series | Turkey | 5 | Mean = 59 yo; 2 females; 3 males. | Epidermolysis bullosa acquisita | Mean = 8.8 y. | Pat. 1,2,3 and 5 - RTX (375mg/m2) 4 weekly cycles + IVIG (2 g/kg/ month) monthly (24, 25, 26, and 10 cycles, respectively); Pat.4 – RTX- 2 cycles of 3 consecutive weeks + IVIG monthly- (12 cycles) | Mean = 22.6 mo. | Improvement of skin and mucosal lesions. | Fever, shivering, and urticaria-like eruption in pat 0.2. |
Birnbaum et al., 2017 [27]. | Case report | USA | 1 | 35 yo; female | Sjögren with sensory neuronopathy | 2 mo | RTX − 375mg/m2 − 2 doses weekly followed by 1 dose RTX every 10 weeks; + IVIg (0.5 g/kg) every 2–3 weeks. - | 23 mo | After 6 RTX doses- the patient, who used a wheelchair, became able to ambulate with a cane. | ND |
Lima et al., 2022 [28]. | Case series | USA | 3 | 32 yo, 40 yo,61 yo 100% males | Refractory vasculitis neuropathy (1 granulomatosis with poliangeiitis) | Pat1-2 y; Pat 2–6 y; Pat 3–4 y; | Pat 1: RTX 1 g, twice (2 weeks apart) + 1 g every 4 months; IVIg 400 mg/kg monthly; MMF 2 g/day. Pat 2: RTX- ND; IVIg- 1 g/kg/every 4 weeks; Pat 3: RTX- ND; IVIg 2 g/kg over 5 days (used twice) | Pat 1- 6mo; Pat 2–3 y; Pat 3 - ND | Pat 1- Regained ability to ambulate with a walker and recovery sensation to pinprick/light touch to 3 cm below the elbow and just above the knees. Pat 2 - Improvement; the patient was able to resume exercises; Pat 3-Improvement of paresthesias. | Pat 1 and 2- none Pat 3 – pneumonia; venous thrombosis + pulmonary embolism |
Cid et al., 2021 [29]. | Case series | Spain | 3 | 48 yo (female), 61 yo (female); 24 yo (male) | Autoimmune thrombotic thrombocytopenic purpura | 1, 1, and 7 days, | RTX- 375 mg/m2/week for 4 weeks IVIg 100–400 mg/Kg Associated with plasma exchange, steroids, and caplacizumab | 6 months, 3 months, and 3 months, respectively. | Pat. 1: improvement with normal platelet count, ADAMTS 13 activity 100%, and negative anti-ADAMTS 13. Pat. 2: improvement with normal platelet count, ADAMTS 13 activity 19%, and negative anti-ADAMTS 13. Pat. 3: improvement with normal platelet count, ADAMTS 13 activity 100%, and negative anti-ADAMTS 13. | None |
Cheikh et al., 2022 [30]. | Case report | Saudi Arabia | 1 | 33 yo; male | Neuropsychiatric Lupus + Lupus nephritis CNS symptoms- one week after extubating from a septic shock | 1 year | IVIg – 0,4 g/kg/day for 5 days + RTX- 500 mg once + methylprednisolone 1 g/5 days | 4 mo | Improvement of CNS symptoms after 5 days. 3 weeks after IVIg and RTX, he was started on MMF and antimalarials. 4 mo later - marked improvement of CNS manifestations and remission of nephritis. | ND |
Castillo et al., 2022 [31]. | Case report | Canada | 1 | 23 yo; Male | Autoimmune hemolytic anemia with Epstein Barr proliferation in a post-heart transplant | 1 week | IVIg- 1 g/kg for 2 days; RTX (one dose)- 700 mg | 5 mo | Improvement; the hemoglobin went from 3.1 g/dL to 14.8 g/dL | MSSA pneumonia |