Promising Treatment Alternatives

The current therapeutic approach to the difficult manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE) remains empirical and is based on clinical experience. Available data on the use of rituximab in refractory NPSLE come from a large number of case reports and some open-label studies. Two patients with persistently active NPSLE, despite conventional therapy, responded dramatically to rituximab are described in this chapter. Current evidence on the therapeutic use of rituximab in this chapter is also analyzed through the English-language literatures. Evidence for the effectiveness of rituximab as induction therapy in NPSLE is based solely on several case reports and non-controlled trials. Although it is not yet possible to make definite recommendations, the global analysis of these cases supports the off-label use of rituximab in cases of severe refractory NPSLE. Furthermore, we present the blockade of new targets which may impact the future treatment of NPSLE.