Rituximab for Systemic Sclerosis (Scleroderma)

Evidence-Based Rationale

• The European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) conditionally recommend rituximab for SSc-ILD, as seen in this patient with early interstitial lung disease on HRCT and moderately reduced DLCO (65% predicted) 1, 2
• The patient has active skin disease despite being on mycophenolate mofetil (MMF) 1g twice daily, indicating inadequate response to first-line therapy, and rituximab is an appropriate second-line agent for skin disease not responding to MMF 1
• The ACR/CHEST guidelines recommend rituximab for SSc-ILD, and the RECITAL trial demonstrated that rituximab was comparable to cyclophosphamide for CTD-ILD with fewer adverse events 1, 2

Treatment Algorithm for This Patient

• The patient has already failed MMF for skin disease despite adequate dosing (1g twice daily), and rituximab is an appropriate second-line agent for skin disease not responding to MMF, as well as for early ILD to prevent progression 1, 2

Monitoring Recommendations

• Regular assessment of skin thickness using modified Rodnan Skin Score is recommended, as well as pulmonary function tests every 3-6 months to monitor lung function 1, 2
• Continued monitoring of other organ systems as per standard of care for SSc is necessary, with vigilance for infections, particularly respiratory infections 1, 2