Abstract
We looked at outcomes for nine SLE patients treated at University College London Hospitals (UCLH) with obinutuzumab, a humanised anti-CD20 mAb, between January 2020 and October 2023. Patients previously failed rituximab for intolerance and/or secondary non-depletion, non-response.
All patients with SLE treated with obinutuzumab at UCLH with at least 6 months follow-up after treatment were included. Patient electronic records were reviewed retrospectively. Data collected included patient demographics, disease duration, previous and concomitant treatments, clinical and laboratory assessments of disease activity, and adverse events.
8/9 patients were female. Mean age was 31.1 years (range 19-48). Mean disease duration was 10.4 years (range 2-23). 7/9 patients had active lupus nephritis. All patients had previously received rituximab, mean of 3.5 courses (2x1g) (range 1-6). All patients were on oral prednisolone (mean dose 20mg, range 5-40mg) and at least one concomitant immunosuppressant. Patients had received an average of 5.7 previous therapies prior to obinutuzumab (range 3-8). The table included demonstrates results pre-obinutuzumab, at 6- and 12-months post-treatment. All patients improved with treatment and all achieved partial renal response (>50% improvement in proteinuria) within 9 months (mean 4.6 months), one requiring additional cyclophosphamide to achieve this. Mean number of inpatient days was 18.7 in the 12 months prior to obinutuzumab and 8.7 in the 12 months post-treatment. Two patients developed infections requiring inpatient treatment in the year following their first obinutuzumab treatment. No other major adverse effects were documented. 3/9 patients required escalation of lupus therapy within a year of obinutuzumab.
Alternative anti-CD20 mAbs such as obinutuzumab can be used effectively in patients with intolerance and/or secondary non-depletion, non-response to rituximab. All the patients in our study had clinical and biochemical benefit from obinutuzumab, evidenced by improvement in SLEDAI scores, proteinuria and serological markers of disease activity. Most patients managed to reduce their steroid dose over the year following treatment. Hospital admissions and inpatient days were reduced in the year following treatment. Efficacy of obinutuzumab in the treatment of lupus nephritis has been reported in a published phase II trial and full results from a phase III trial are awaited.
V.M.K. Joseph: None. V. Reddy: None. C. Fisher: None. R. Pepper: None. M. Ehrenstein: None. C. Ciurtin: None. M. Leandro: None.
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