RITUXIMAB VERSUS CYCLOPHOSPHAMIDE FOR THE TREATMENT OF CONNECTIVE TISSUE DISEASE ASSOCIATED INTERSTITIAL LUNG DISEASE (RECITAL): A SUBGROUP ANALYSIS OF A MULTI-CENTRE RANDOMISED CONTROLLED TRIAL
Authors: T. Maher et al
The RECITAL trial randomized 101 patients with severe or progressive interstitial lung disease due to idiopathic inflammatory myositis (IIM), systemic sclerosis (SSc) or mixed connective tissue disease (MCTD) to either rituximab (2g) or cyclophosphamide (600mg/m2 body surface area every 4 weeks) as first line therapy. At 24 weeks, both rituximab and cyclophosphamide resulted in an improvement in the primary endpoint of FVC and resulted in improvement in measures of quality of life. This abstract analysed the effect of rituximab and cyclophosphamide by CTD sub-group.
44 subjects had IIM, 37 had SSc and 16 had MCTD. At 24 weeks, in the IIM subgroup both rituximab and cyclophosphamide resulted in an improvement in FVC (241 mL and 345 mL respectively). In MCTD patients the 24 week FVC change from baseline was 208 mL and 165 mL for rituximab and cyclophosphamide, whilst in SSc patients the FVC changes were -26 mL and -3 mL respectively. In SSc rituximab but not cyclophosphamide slightly improved SSc skin thickness.
Although the interpretation of this small study is limited by its lack of a placebo group, it suggests that SSc-associated ILD (unlike the ILD in other CTDs) responds less favorably to rituximab and cyclophosphamide.