Serological and clinical outcomes of rituximab in antiphospholipid syndrome with or without SLE: a retrospective single-centre cohort

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ID: 338084
2026
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Abstract
OBJECTIVES: To assess the dynamics of aPL titres after rituximab treatment, durability of serological responses, recurrent thrombosis, and safety in patients with APS. METHODS: This retrospective study included 54 patients, predominantly with SLE-associated APS (n = 43), who received at least one course of rituximab. aCL and anti-β2-glycoprotein I (aβ2GPI) IgG/IgM were evaluated at baseline and 6-12 months after treatment. Long-term serological, clinical and safety outcomes were analysed over a median follow-up period of 4.7 years. RESULTS: At 6-12 months, positivity rates decreased significantly for aCL IgG (59.3% to 24.1%), aCL IgM (24.1% to 5.6%), aβ2GPI IgG (42.6% to 16.7%), and aβ2GPI IgM (20.4% to 5.6%) (all P <0.05). Long-term serological data were available for 31 patients. At last follow-up, aβ2GPI IgG positivity remained lower than baseline (P = 0.039), whereas quantitative titres were no longer significantly different. Long-term serological changes did not differ according to rituximab cycle number. Thrombotic recurrence occurred in five patients, four of whom were either off anticoagulation or had subtherapeutic INR values. Fifteen patients developed bacterial infections, seven SARS-CoV-2 infections, and five patients died during follow-up, including one who died from sepsis. CONCLUSION: Rituximab was associated with marked short-term reductions in aPL titres and positivity, although quantitative suppression was not sustained long term. Changes in aCL/aβ2GPI did not consistently reflect thrombotic risk. These findings suggest that rituximab may be a valuable adjunctive therapy in selected patients with difficult-to-treat APS, although causality cannot be established from this retrospective study.
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Authors Ömer Uludağ, Gamze Kemeç, Soner Altin, Burak İnce, Yasemin Yalçınkaya, Sevil Kamalı, Ahmet Gül, Murat İnanç, Bahar Artım-Esen
Journal Lara D. Veeken
Year 2026
DOI
10.1093/rheumatology/keag609
URL
https://doi.org/10.1093/rheumatology/keag609
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