Following COVID-19 vaccination and pneumocystis jirovecii pneumonia prophylaxis, the patient received rituximab (two 1 g doses at a two-week dosing interval) treatment and continued on mycophenolate mofetil, 2 g daily. Six months later, the rituximab regimen was repeated. In the first year following rituximab initiation, no infections needing antibiotic therapy occurred. Repeat lung function tests were performed and rituximab therapy continued at six-month intervals with nintedanib kept in reserve for further SSc-ILD progression.
Key Takeaways
“The main takeaways are that immunosuppression should always be considered for SSc-ILD and may need to include multiple drugs, and that ANAs used for diagnosis of SSc also help with patient stratification for risk of progressive ILD,” Dr. Denton says.
“Data from clinical trials in SSc-ILD have been extrapolated to inform management strategies in ILD related to other autoimmune rheumatic diseases. Within the immune system, routinely used treatments, such as rituximab and mycophenolate mofetil, that target B cells are beneficial. However, there is room for further improvement. Current clinical trials include exciting cellular therapy, such as CAR T and CAR NK [natural killer], to achieve more complete or durable B cell depletion with the potential to ‘reset’ the immune system and clear the autoreactive B cells,” Dr. Denton concludes. “Potential benefit and durability of these approaches will need to be carefully balanced with safety, cost and feasibility.”
Katie Robinson is a medical writer in New York.
Disclosures
Dr. Denton has received consultancy or speaker fees from Janssen, GlaxoSmithKline, Bayer, Sanofi, Boehringer Ingelheim, Roche, CSL Behring, Corbus, Acceleron, Horizon, Arxx, Lilly, Novartis and Certa.
Dr. Ong has received speaker fees from Boehringer Ingelheim.
Dr. Goldman declares no conflicts of interest.
References
- Bucala R, Solomon DH. Immunology for the rheumatologist: Arthritis & Rheumatology introduces a new problem-based immunology review series with great educational potential. Arthritis Rheumatol. 2024 Jan;76(1):9–10.
- Goldman N, Ong V, Denton C. B cells and systemic sclerosis interstitial lung disease. Arthritis Rheumatol. 2025 Jul 20. Epub ahead of print.
