{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:31:13Z","timestamp":1787992273349,"version":"build-2784847793"},"reference-count":55,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,6,5]],"date-time":"2022-06-05T00:00:00Z","timestamp":1654387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000659","name":"Research Trainees Coordinating Centre","doi-asserted-by":"publisher","award":["CS\u20102013\u201013\u2010032"],"award-info":[{"award-number":["CS\u20102013\u201013\u2010032"]}],"id":[{"id":"10.13039\/501100000659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000659","name":"Research Trainees Coordinating Centre","doi-asserted-by":"publisher","award":["DRF\u20102014\u201007\u2010155"],"award-info":[{"award-number":["DRF\u20102014\u201007\u2010155"]}],"id":[{"id":"10.13039\/501100000659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["ISSF(204825\/Z\/16\/Z)"],"award-info":[{"award-number":["ISSF(204825\/Z\/16\/Z)"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ACR Open Rheumatology"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess outcomes of repeat rituximab cycles and identify predictors of sustained clinical response in systemic manifestations of primary Sj\u00f6gren syndrome (pSS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An observational study was conducted in 40 rituximab\u2010treated patients with pSS. Clinical response was defined as a 3\u2010point or more reduction in the European League Against Rheumatism (EULAR) Sj\u00f6gren Disease Activity Index (ESSDAI) at 6 months from baseline. Peripheral blood B cells were measured using highly sensitive flow cytometry. Predictors of sustained response (within two rituximab cycles) were analyzed using penalized logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010eight out of 40 patients had moderate to severe systemic disease (ESSDAI &gt;5). Main domains were articular (73%), mucocutaneous (23%), hematological (20%), and nervous system (18%). Twenty\u2010eight out of 40 (70%) patients were on concomitant immunosuppressants. One hundred sixty\u2010nine rituximab cycles were administered with a total follow\u2010up of 165 patient\u2010years. In cycle 1 (C1), 29\/40 (73%) achieved ESSDAI response. Of C1 responders, 23\/29 received retreatment on clinical relapse, and 15\/23 (65%) responded. Of the 8\/23 patients who lost response, these were due to secondary non\u2010depletion and non\u2010response (2NDNR; 4\/23 [17%] as we previously observed in systemic lupus erythematosus with antirituximab antibodies, inefficacy\u00a0=\u00a02\/23, and other side effects\u00a0=\u00a02\/23). Within two cycles, 13\/40 (33%) discontinued therapy. In multivariable analysis, concomitant immunosuppressant (odds ratio 7.16 [95% confidence interval: 1.37\u201337.35]) and achieving complete B\u2010cell depletion (9.78 [1.32\u201372.25]) in C1 increased odds of response to rituximab. At 5\u2009years, 57% of patients continued on rituximab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our data suggest that patients with pSS should be co\u2010prescribed immunosuppressant with rituximab, and treatment should aim to achieve complete depletion. About one in six patients develop 2NDNR in repeat cycles. Humanized or type 2 anti\u2010CD20 antibodies may improve clinical response in extra\u2010glandular pSS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr2.11466","type":"journal-article","created":{"date-parts":[[2022,6,5]],"date-time":"2022-06-05T20:44:57Z","timestamp":1654461897000},"page":"689-699","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Predicting Sustained Clinical Response to Rituximab in Moderate to Severe Systemic Manifestations of Primary Sj\u00f6gren Syndrome"],"prefix":"10.1002","volume":"4","author":[{"given":"Sophanit","family":"Pepple","sequence":"first","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Arnold","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds  Leeds 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