Rheumatology (Oxford, England) · 2026
Real-world experience with obinutuzumab in difficult-to-treat myositis: concise report of a case series.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Ilic Ivana, Narain Sonali, Marder Galina
Аннотация
OBJECTIVES: Idiopathic inflammatory myopathy (IIM) is an orphan systemic disorder with muscular, cutaneous and pulmonary involvement. B cell-directed therapies, including rituximab, belimumab and chimeric antigen receptor T-cell (CAR-T), have shown promise in altering disease outcome. We report the benefit of obinutuzumab in difficult -to- treat myositis patients.
METHODS: The Northwell Rheumatology database was searched for obinutuzumab-treated patients (2019-24); five of them met 2017 EULAR/ACR classification criteria for IIM and were included in the analysis. Demographic, clinical, serological and imaging data were collected. Overall response was rated as complete, partial or no response based on clinical response and physician global assessment. Total improvement score was not calculated because data were collected retrospectively. Descriptive statistics were used for analyses.
RESULTS: Of five patients, two had antisynthetase syndrome, one dermatomyositis (DM) and two overlap myositis. Most patients failed at least three immunosuppressive agents. The reason for obinutuzumab use was rituximab allergy and worsening of interstitial lung disease (ILD) and myositis activity (3/5), arthritis (2/5) and severe rash (1/5 patients), despite rituximab. After obinutuzumab 80% of patients had overall improvement by 3-6 months. Respiratory status improved/stabilized in all ILD patients. Two patients required second obinutuzumab cycle: one for recurrence and another for persistent disease with B cell re-population. One was lost to follow-up after the second cycle and was deemed a non-responder. At last observation, 4/5 patients had achieved a complete response. No hypogammaglobulinaemia, significant infections or hospitalizations were observed.
CONCLUSION: Obinutuzumab was safe and provided durable improvement in difficult-to-treat myositis patients with rituximab allergy, further highlighting targeting the B-cell pathway.
METHODS: The Northwell Rheumatology database was searched for obinutuzumab-treated patients (2019-24); five of them met 2017 EULAR/ACR classification criteria for IIM and were included in the analysis. Demographic, clinical, serological and imaging data were collected. Overall response was rated as complete, partial or no response based on clinical response and physician global assessment. Total improvement score was not calculated because data were collected retrospectively. Descriptive statistics were used for analyses.
RESULTS: Of five patients, two had antisynthetase syndrome, one dermatomyositis (DM) and two overlap myositis. Most patients failed at least three immunosuppressive agents. The reason for obinutuzumab use was rituximab allergy and worsening of interstitial lung disease (ILD) and myositis activity (3/5), arthritis (2/5) and severe rash (1/5 patients), despite rituximab. After obinutuzumab 80% of patients had overall improvement by 3-6 months. Respiratory status improved/stabilized in all ILD patients. Two patients required second obinutuzumab cycle: one for recurrence and another for persistent disease with B cell re-population. One was lost to follow-up after the second cycle and was deemed a non-responder. At last observation, 4/5 patients had achieved a complete response. No hypogammaglobulinaemia, significant infections or hospitalizations were observed.
CONCLUSION: Obinutuzumab was safe and provided durable improvement in difficult-to-treat myositis patients with rituximab allergy, further highlighting targeting the B-cell pathway.