Efficacy of Rituximab for Refractory Pyoderma Gangrenosum-Like Ulcers in Granulomatosis With Polyangiitis Associated to Antiphospholipid Antibodi

• Published in: Turkish journal of rheumatology Vol. 35; no. 3; pp. 449 - 453
• Main Authors: Riera, Julia, Musuruana, Jorge, Costa, Cecilia, Cavallasca, Javier
• Format: Journal Article
• Language: English
• Published: Istanbul Prof Sebnem Ataman, President Turkish League Against Rheumatism 01-01-2020
• Subjects: Antibodies; Authorship; Autoimmune diseases; Deoxyribonucleic acid; Disease; DNA; Medical imaging; Monoclonal antibodies; Neutrophils; Patients; Rheumatoid arthritis; Rheumatology; Skin diseases; Thrombosis; Tumor necrosis factor-TNF; Ulcers
• ISSN: 1309-0291; 1309-0283
• DOI: 10.46497/ArchRheumatol.2020.7498

[...]infliximab (IFX) is the only biologic that has shown efficacy in classic PG in a randomized, double-blind, controlled trial (level 1 evidence).2 Rituximab (RTX) was approved for use in GPA by the Food and Drug Administration in April 2011. Cyclophosphamide was restarted for a six-month period, with prednisone in tapering doses. Since there was no renal involvement and due to the severity of the arthritis, leflunomide 20 mg/day, and MTX 15 mg/week were added. Emerging evidence of the clinical efficacy of TNF-a inhibitor therapy for the treatment of PG strongly suggests a key role for this cytokine in the disease.2 Pyoderma gangrenosum treatment varies depending on the severity of the lesion and may either respond to local therapies or require immunosuppressive agents such as corticosteroids, MTX, AZA or mycophenolate mofetil. Gammaglobulin and cyclophosphamide are also prescribed for refractory cases,2 while biologic drugs such as IFX or RTX would be another option in these patients.9 On the other hand, RTX has demonstrated efficacy in cutaneous ulcers secondary to APS that were resistant to anticoagulation.10,11 Our patient received corticosteroids, cyclophosphamide, MTX, AZA, leflunomide and IVIG to treat the different manifestations of the disease.