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Swetha Dhanireddy, Robert Swan, C. Stephen Foster; Long-term Maintenance Therapy of Rituximab in Treatment of Noninfectious Scleritis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):426. doi: https://doi.org/.
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To review the outcomes of long-term maintenance therapy with rituximab which followed an eight-weekly then six-monthly rituximab infusion regimen in patients with severe noninfectious scleritis refractory to systemic corticosteroids and conventional immunomodulatory therapy.
Retrospective case series. Reviewed medical charts of patients with noninfectious scleritis refractory to conventional immunomodulatory therapy treated with initial eight-weekly then six-monthly protocol who were then extended to a maintenance regimen. Patients were seen at the Upstate Medical University Ophthalmology clinic or Massachusetts Eye Research & Surgery Institution between 2014 and 2017. The primary outcome measure was ability to maintain disease remission after extended, maintenance rituximab regimen. Secondary outcome measure was ability to decrease corticosteroid dependence.
Four patients were identified. The mean follow-up duration was 26 months. After completing eight-weekly then six-monthly rituximab infusions each patient achieved disease remission. Two patients were extended to rituximab infusions every three months, one patient was extended to every two months, and one patient received monthly infusions. Continuing rituximab at extended intervals showed durable remission and ability to continue corticosteroid tapering three out of four patients. To date, one patient has been disease-free for 13 months and significant decrease in corticosteroid dependence. One patient has been disease-free for 13 months and steroid-free for seven months. One patient has been disease-free for 34 months and systemic steroid-free for 33 months.
The initial eight-weekly followed by six-monthly rituximab infusion protocol is a treatment of last resort for severe, recalcitrant, noninfectious scleritis. Though effective at achieving remission, there is not any published guidance on subsequent maintenance therapy. Our case series reflects that long-term remission and corticosteroid tapering can be obtained in some patients with extension of the interval of rituximab. Additional study is essential to determine an optimal long-term maintenance protocol for patients with severe disease.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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