The aim of this study was to observe the clinical efficacy and safety of rituximab (RTX) combination with telitacicept (TA) in patients of systemic lupus erythematosus secondary antiphospholipid syndrome (APS).
In this multicenter, prospective, observational study, 80 patients with SLE Secondary APS patients were enrolled. RTX alone or its continuation with TA was observed for 24weeks，and extended for another 24 weeks. At week 12, the RTX group could be converted to the combination group. The primary end point was the response rate of total antiphospholipid antibody (aPL) at week 12. The secondary end points included the decline rate and value of aPL antibody, aGAPSS score, remission degree of specific clinical indicators, changes in SLE disease activity in SAPS group, and drug safety at week 12 and week 24.
Study Type
OBSERVATIONAL
Enrollment
80
160mg once a week for 24 weeks
Patients received 200mg of rituximab intravenously at week 0 and week 2.
50-100mg, po, once per day (Qd) prescribed if needed and adjusted due to patient response
Qilu Hospital
Jinan, Shandong, China
RECRUITINGThe proportion of patients who achieved response(complete response and partial response) in aPL profiles
For the lupus anticoagulant (LAC) test, we defined complete response (CR) as a negative test result and no response(NR) as a positive test result； For the anticardiolipin antibody (aCL)/anti-β2 glycoprotein I (anti-β2GPI)enzyme-linked immunosorbent assay,CR was defined as a titer of\<the 95th percentile, partial response (PR) was defined as a titer of 95th -99th , and NR was defined as a titer of \>the 99th percentile.
Time frame: Week 12
The proportion of patients who achieved response(complete response and partial response) in aPL profiles
For the lupus anticoagulant (LAC) test, we defined complete response (CR) as a negative test result and no response(NR) as a positive test result； For the anticardiolipin antibody (aCL)/anti-β2 glycoprotein I (anti-β2GPI)enzyme-linked immunosorbent assay,CR was defined as a titer of\<the 95th percentile, partial response (PR) was defined as a titer of 95th -99th , and NR was defined as a titer of \>the 99th percentile.
Time frame: Week 24,48
The change of aPL titer
titer change of lupus anticoagulant, anticardiolipin antibody and anti-β2 glycoprotein-I antibody
Time frame: week 12 , 24,48
The changes of the positive number of 7 aPL indicators
Change in the number of antibody positives.
Time frame: week 12, 24,48
The change of clinical efficacy in subgroups with different symptoms
Thrombocytopenia, haemolytic anemia, nephropathy, heart valve lesions, skin changes (livedo reticularis, leg ulcers)
Time frame: Before the screening,baseline and week 12,24,48
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Warfarin should be used in patients with arterial thrombosis, and rivaroxaban should be replaced if the patient cannot reach the standard or cannot tolerate it
200mg, po, twice per day (Bid) prescribed，if tolerated by the patient， the dose should remain constant during the observation period
5-30mg, po, once per day(Qd) prescribed if needed and adjusted due to patient response
The change of aGAPSS score
The aGAPSS was calculated by adding the points corresponding to the risk factors: three for hyperlipidemia, one for arterial hypertension, five for positive anticardiolipin antibodies, four for positive anti-β2 glycoprotein-I antibodies and four for positive lupus anticoagulant test.
Time frame: Before the screening,baseline and week 12,24,48
The change of Damage Index for Antiphospholipid Syndrome (DIAPS)
The score is obtained by adding the output rating for each domain. The instrument demonstrated content, criterion, and construct validity being a precise tool to quantify organ damage in APS.
Time frame: Before the screening and week 12,24,48
The change of Physician Global Assessment (PGA) score .
PGA is a physician-reported visual analogue scale that provides an overall meas- ure of the subject's current disease activity,the PGA is a visual analog scale scored from 0 to 3. A score of 1 corresponds to mild lupus disease activity. A score of 2 correlates with moderate disease activity and a score of 3 with severe disease activity;
Time frame: Before the screening,baseline and week 12,24,48
The change of Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2k) Score
The SLEDAI-2K is an established, validated SLE activity index. It is based on the presence of 24 features in 9 organ systems and measures disease activity in SLE patients in the previous 10 days.
Time frame: Before the screening,baseline and week 12,24,48
The percentage of patients with Lupus Low Disease Activity State (LLDAS)
LLDAS is defined as: (1) SLE Disease Activity Index (SLEDAI)-2K ≤4, with no activity in major organ systems (renal, central nervous system (CNS), cardiopulmonary, vasculitis, fever) and no haemolytic anaemia or gastrointestinal activity; (2) no new lupus disease activity compared with the previous assessment; (3) a Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI physician global assessment (scale 0-3) ≤1; (4) a current prednisolone (or equivalent) dose ≤7.5 mg daily; and (5) well tolerated standard maintenance doses of immunosuppressive drugs and approved biological agents.
Time frame: Before the screening,baseline and week 12,24,48
Glucocorticoid (GC) dose and reduction rate
The proportion of patients who received the GC dose at each time point
Time frame: Before the screening,baseline and week 4,12,24,48