- Design
- Retrospective single-centre cohort
- Population
- 54 patients with antiphospholipid syndrome (43 with SLE) given rituximab
- Primary outcome
- Antiphospholipid antibody positivity and thrombotic recurrence
- Effect
- aCL IgG positivity 59.3% to 24.1% at 6–12 months; 5 recurrences
A single-centre retrospective series described 54 patients with antiphospholipid syndrome, 43 with lupus, who received rituximab, followed for a median 4.7 years.
At 6 to 12 months, positivity fell for anticardiolipin IgG (59.3% to 24.1%) and anti-β2-glycoprotein I IgG (42.6% to 16.7%). By last follow-up, titres were no longer significantly lower. Five patients had recurrent thrombosis, four of them off anticoagulation or with a subtherapeutic INR. Fifteen had bacterial infections and one died of sepsis.
The series suggests rituximab may help selected difficult cases, but antibody falls did not track thrombotic risk, and anticoagulation remained the decisive factor.
- Keep anticoagulation central in antiphospholipid syndrome, even when rituximab is added
- Check INR control closely in anyone with recurrent thrombosis
- Do not use falling antibody titres as a reason to stop anticoagulation
- Monitor for infection after rituximab
Why it matters
Antibody levels after rituximab are not a reliable guide to clotting risk.
Don't overread it
A small retrospective series without controls; causality cannot be established.
The statistics, in plain English
The falls in positivity are large, but without a comparison group it is unclear how much would have happened anyway. Five thromboses in 54 patients is too few to judge protection.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for rheumatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free