Sjögren keratoconjunctivitis sicca treated with rituximab.

Purpose: To report two clinical cases of patients having severe keratoconjunctivitis sicca refractive to conventional treatment that received rituximab, a chimeric monoclonal antibody specific for human CD20 that targets B lymphocytes.

Methods: Clinical description and review of the literature.

Results: After treatment with rituximab, there was a marked improvement in their keratoconjunctivitis sicca and in other systemic manifestations of the disease. The patients also report a better quality of life in regard to sicca symptoms. B cells seem to play an important role in the pathogenesis of Sjögren syndrome. Rituximab produces immunoablation and has been used in various autoimmune diseases and cancer with a secure profile.

Conclusion: We demonstrate improvement in Schirmer test values, tear film breakup time, visual acuity, symptomatology, and vital staining in two patients with refractory queratoconjunctivitis sicca secondary to Sjögren syndrome. It is probable that drugs like rituximab could be of help in patients in unresponsive cases of keratoconjunctivitis sicca secondary to Sjögren syndrome. This case report serves as the basis to justify a multicenter, randomized, placebo-controlled clinical trial.