Abstract | CONTEXT: OBJECTIVE: DESIGN AND INTERVENTION: This was an open-label, pilot study of B lymphocyte depletion therapy in new-onset idiopathic primary adrenal failure. Doses of iv rituximab (1 g) were given on d 1 and 15, after pretreatment with 125 mg iv methylprednisolone. PATIENTS AND MAIN OUTCOME MEASURES: Six patients (aged 17-47 yr; four females) were treated within 4 wk of the first diagnosis of idiopathic primary adrenal failure. Dynamic testing of adrenal function was performed every 3 months for at least 12 months. RESULTS: Serum cortisol levels declined rapidly and were less than 100 nmol/liter (3.6 μg/dl) in all patients by 3 months after B lymphocyte depletion. Serum cortisol and aldosterone concentrations remained low in five of the six patients throughout the follow-up period. However, a single patient had sustained improvement in both serum cortisol [peak 434 nmol/liter (15.7 μg/dl)] and aldosterone [peak 434 pmol/liter (15.7 ng/dl)] secretion. This patient was able to discontinue steroid medications 15 months after therapy and remains well, with improving serum cortisol levels 27 months after therapy. CONCLUSION:
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Authors | Simon H S Pearce, Anna L Mitchell, Stuart Bennett, Phil King, Sukesh Chandran, Sath Nag, Shu Chen, Bernard Rees Smith, John D Isaacs, Bijay Vaidya |
Journal | The Journal of clinical endocrinology and metabolism
(J Clin Endocrinol Metab)
Vol. 97
Issue 10
Pg. E1927-32
(Oct 2012)
ISSN: 1945-7197 [Electronic] United States |
PMID | 22767640
(Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antibodies, Monoclonal, Murine-Derived
- Glucocorticoids
- Immunologic Factors
- Aldosterone
- Rituximab
- Hydrocortisone
- Methylprednisolone
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Topics |
- Addison Disease
(drug therapy, immunology)
- Adolescent
- Adrenal Cortex
(immunology)
- Adult
- Aldosterone
(blood)
- Antibodies, Monoclonal, Murine-Derived
(administration & dosage)
- B-Lymphocytes
(immunology)
- Female
- Glucocorticoids
(administration & dosage)
- Humans
- Hydrocortisone
(blood)
- Immunologic Factors
(administration & dosage)
- Lymphocyte Depletion
(methods)
- Male
- Methylprednisolone
(administration & dosage)
- Middle Aged
- Pilot Projects
- Rituximab
- Treatment Outcome
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