Response to: ‘Is rituximab effective for IgG4-related disease in the long term? Experience of cases treated with rituximab for 4 years’ by Yamamoto et al

Published on Aug 1, 2015in Annals of the Rheumatic Diseases16.102
· DOI :10.1136/ANNRHEUMDIS-2015-207640
John H. Stone76
Estimated H-index: 76
(Harvard University),
Mollie N. Carruthers15
Estimated H-index: 15
(Harvard University)
+ 7 AuthorsSuresh T. Chari83
Estimated H-index: 83
(Mayo Clinic)
We thank Yamamoto and colleagues1 for their response to our paper2 and their description of their experience with rituximab (RTX) in IgG4-related disease (IgG4-RD) in three patients. Their letter raises a number of important points pertaining to the management of IgG4-RD, in general, and to the use of B-cell-depletion strategies, specifically. First, their patients are exemplary of the fact a sizeable subset of IgG4-RD patients has a propensity to disease relapse over time. This point has been underappreciated from early reports of the use of glucocorticoids to treat IgG4-RD because those reports were characterised by short follow-up periods. Although the great majority of patients respond to glucocorticoids initially, repeated disease flares are the rule for many. Second, patients with IgG4-RD endure substantial morbidity from the requirement for repeated courses (or continuous on treatment) with glucocorticoids. The three patients described by Yamamoto and colleagues are reported to have experienced bilateral avascular necrosis of the hips and glucose intolerance (severe diabetes mellitus in one case). Our general sense is that the toxicities of prolonged glucocorticoid use in this and other diseases are underestimated. Moreover, patients …
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