RITUXIMAB USE IN CHILDREN WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A RETROSPECTIVE ANALYSIS OF A CLINICAL CASE SERIES

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To analyze the efficacy and safety of rituximab therapy in children and adolescents with systemic lupus erythematosus (SLE). Materials and methods. A retrospective analysis of data from 21 patients with SLE (median age 14,0 [10,0; 15,0] years, 81% female) who received at least one rituximab infusion which was performed between 2016 and 2025. The dynamics of the SLEDAI activity index, organ-specific response, glucocorticosteroid dose, laboratory parameters, and the frequency of adverse events were assessed at 6 and 12 months of follow-up. Results. Rituximab therapy resulted in a statistically significant reduction in the SLEDAI index from 16,5 [11,0; 18,8] to 2,0 [2,0; 4,0] points at 6 months and to 2,0 [0,5; 2,0] points at 12 months (p<0,001). Low disease activity (SLEDAI ≤5) at 12 months was achieved in 95% of patients. A significant decrease was noted in the daily prednisolone dose from 40,0 [31,3; 50,0] to 15,0 [10,0; 20,0] mg (p=0,002) and in the weight-adjusted prednisolone dose from 1,00 [1,00; 1,00] to 0,26 [0,21; 0,32] mg/kg/day (p<0,001). Complete organ-specific response was achieved in 85,7% of patients. A significant reduction in immunoglobulin levels (IgG, IgM, IgA) was recorded (p≤0,001). Adverse events were observed in 28,6% of patients, with hypogammaglobulinemia requiring intravenous immunoglobulin being the most frequent. One fatal outcome (4,8%) occurred in a female patient with refractory SLE and multiorgan involvement. Conclusion. Rituximab demonstrated high clinical efficacy in controlling disease activity and a steroid-sparing effect in children with SLE. The safety profile of the drug was consistent with global data and requires careful monitoring for infectious complications and immunoglobulin levels.

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