***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective . To assess the efficacy of rituximab ( RTX ) in SSc . Methods . Fourteen patients with SSc were evaluated . Eight patients were r and omized to receive two cycles of RTX at baseline and 24 weeks [ each cycle consisted of four weekly RTX infusions ( 375 mg/m2 ) ] in addition to st and ard treatment , whereas six patients ( control group ) received st and ard treatment alone .  Lung involvement was assessed by pulmonary function tests ( PFTs ) and chest high-resolution CT ( H RCT ) . Skin involvement was assessed both clinical ly and histologically . Results . There was a significant increase of forced vital capacity ( FVC ) in the RTX group compared with baseline ( mean ± s.d . : 68.13 ± 19.69 vs 75.63 ± 19.73 , at baseline vs 1-year , respectively , P = 0.0018 ) . The median percentage of improvement of FVC in the RTX group was 10.25 % , whereas that of deterioration in the controls was 5.04 % ( P = 0.002 ) . Similarly , diffusing capacity of carbon monoxide ( DLCO ) increased significantly in the RTX group compared with baseline ( mean ± s.d . : 52.25 ± 20.71 vs 62 ± 23.21 , at baseline vs 1-year respectively , P = 0.017 ) . The median percentage of improvement of DLCO in the RTX group was 19.46 % , whereas that of deterioration in the control group was 7.5 % ( P = 0.023 ) . Skin thickening , assessed with the Modified Rodnan Skin Score ( MRSS ) , improved significantly in the RTX group compared with the baseline score ( mean ± s.d . : 13.5 ± 6.84 vs 8.37 ± 6.45 at baseline vs 1-year , respectively , P < 0.001 ) . Conclusion . Our results indicate that RTX may improve lung function in patients with SSc . To confirm our encouraging results we propose that larger scale , multicentre studies with longer evaluation periods are needed Objectives ( 1 ) Hypothesis testing of the potency of rituximab ( RTX ) in preventing fibrotic complications and ( 2 ) assessing acceptability and feasibility of RTX in early systemic sclerosis ( SSc ) . Methods A small , 24-month , r and omised , double-blind , placebo-controlled , single-centre trial in patients with SSc diagnosed < 2 years was conducted . Patients received RTX or placebo infusions at t=0 , t=15 days and t=6 months . Patients were clinical ly evaluated every 3 months , with lung function tests and high-resolution CT every other visit . Skin biopsies were taken at baseline and month 3 . Immunophenotyping of peripheral blood mononuclear cells was performed at every visit , except at months 9 and 18 . Adverse events , course of skin and pulmonary involvement and B cell population s in skin and peripheral blood were evaluated . Results In total 16 , patients ( rituximab n=8 , placebo n=8 ) were included . Twelve patients had diffuse cutaneous SSc . Eighty-eight adverse events  ( RTX n=53 , placebo n=35 , p=0.22 ) and 11 serious adverse events  ( RTX n=7 , placebo n=4 , p=0.36 ) occurred . No unexpected RTX-related events were observed . Mean skin score over time did not differ between the groups . Over time , forced vital capacity and extent of lung involvement slightly improved with RTX , but this difference was insignificant . In peripheral blood B cells depletion was demonstrated . Conclusions No unexpected safety issues were observed with RTX in early SSc . Although this small trial could not confirm or reject potential efficacy of RTX in these patients , future placebo-controlled trials are warranted , specifically in the subgroup of patients with pulmonary involvement . Trial registration number EudraCT 2008 - 07180 - 16 ; Results OBJECTIVE B cells are likely to contribute to the pathogenesis of systemic lupus erythematosus ( SLE ) , and rituximab induces depletion of B cells . The Exploratory Phase II/III SLE Evaluation of Rituximab ( EXPLORER ) trial tested the efficacy and safety of rituximab versus placebo in patients with moderately-to-severely active extrarenal SLE . METHODS Patients entered with > or=1 British Isles Lupus Assessment Group ( BILAG ) A score or > or=2 BILAG B scores despite background immunosuppressant therapy , which was continued during the trial . Prednisone was added and subsequently tapered . Patients were r and omized at a ratio of 2:1 to receive rituximab ( 1,000 mg ) or placebo on days 1 , 15 , 168 , and 182 . RESULTS In the intent-to-treat analysis of 257 patients , background treatment was evenly distributed among azathioprine , mycophenolate mofetil , and methotrexate . Fifty-three percent of the patients had > or=1 BILAG A score at entry , and 57 % of the patients were categorized as being steroid dependent . No differences were observed between placebo and rituximab in the primary and secondary efficacy end points , including the BILAG-defined response , in terms of both area under the curve and l and mark analyses . A beneficial effect of rituximab on the primary end point was observed in the African American and Hispanic subgroups . Safety and tolerability were similar in patients receiving placebo and those receiving rituximab . CONCLUSION The EXPLORER trial enrolled patients with moderately-to-severely active SLE and used aggressive background treatment and sensitive cutoffs for nonresponse . No differences were noted between placebo and rituximab in the primary and secondary end points . Further evaluation of patient subsets , biomarkers , and exploratory outcome models may improve the design of future SLE clinical trials Objective . The aim was to assess the efficacy of rituximab for the cutaneous manifestations of adult DM and JDM . Methods . Patients with refractory adult DM ( n = 72 ) and JDM ( n = 48 ) were treated with rituximab in a r and omized placebo-phase-controlled trial [ either rituximab early drug ( week 0/1 ) or rituximab late arms ( week 8/9 ) , such that all subjects received study drug ] . Stable concomitant therapy was allowed . Cutaneous disease activity was assessed using the Myositis Disease Activity Assessment Tool , which grade s cutaneous disease activity on a visual analog scale . A myositis damage assessment tool , termed the Myositis Damage Index , was used to assess cutaneous damage . Improvement post-rituximab was evaluated in individual rashes as well as in cutaneous disease activity and damage scores . The & khgr;2 test , Student ’s paired t-test and Wilcoxon test were used for analysis . Results . There were significant improvements in cutaneous disease activity from baseline to the end of the trial after rituximab administration in both adult DM and JDM subsets . The cutaneous visual analog scale activity improved in adult DM ( 3.22–1.72 , P = 0.0002 ) and JDM ( 3.26–1.56 , P < 0.0001 ) , with erythroderma , erythematous rashes without secondary changes of ulceration or necrosis , heliotrope , Gottron sign and papules improving most significantly . Adult DM subjects receiving rituximab earlier in the trial demonstrated a trend for faster cutaneous response ( 20 % relative improvement from baseline ) compared with those receiving B cell depletion later ( P = 0.052 ) . Conclusion . Refractory skin rashes in adult DM and JDM showed improvement after the addition of rituximab to the st and ard therapy in a clinical trial Introduction An over-expression of CD19 has been shown in B cells of systemic sclerosis ( SSc ) and B cells are thought to contribute to the induction of skin fibrosis in the tight skin mouse model . The aim was to define the outcome on safety and the change in skin score after rituximab therapy in SSc patients and to correlate the clinical characteristics with the levels of interleukin (IL)-6 and with the immune cell infiltrate detected by immunohistochemistry . Methods Nine patients with SSc with mean age 40.9 ± 11.1 years were treated with anti-CD20 , 1 g at time 0 and after 14 days . Skin biopsy was performed at baseline and during the follow-up . B-cell activating factor ( BAFF ) and IL-6 levels were also determined at the follow-up times . Results After 6 months patients presented a median decrease of the skin score of 43.3 % ( range 21.1 - 64.0 % ) , and a decrease in disease activity index and disease severity index . IL-6 levels decreased permanently during the follow up . After treatment , a complete depletion of peripheral blood B cells was observed in all but 2 patients . Only 3 patients presented CD20 positive cells in the biopsy of the involved skin at baseline . Conclusions Anti-CD20 treatment has been well tolerated and SSc patients experienced an improvement of the skin score and of clinical symptoms . The clear fall in IL-6 levels could contribute to the skin fibrosis improvement , while the presence of B cells in the skin seems to be irrelevant with respect to the outcome after B cell depletion . Trial registration IS RCT N77554566 OBJECTIVE To study the efficacy and safety of B cell depletion with rituximab , a chimeric murine/human anti-CD20 monoclonal antibody , in patients with primary Sjögren 's syndrome ( SS ) in a double-blind , r and omized , placebo-controlled trial . METHODS Patients with active primary SS , as determined by the revised American-European Consensus Group criteria , and a rate of stimulated whole saliva secretion of > or = 0.15 ml/minute were treated with either rituximab ( 1,000 mg ) or placebo infusions on days 1 and 15 . Patients were assigned r and omly to a treatment group in a ratio of 2:1 ( rituximab : placebo ) . Followup was conducted at 5 , 12 , 24 , 36 , and 48 weeks . The primary end point was the stimulated whole saliva flow rate , while secondary end points included functional , laboratory , and subjective variables . RESULTS Thirty patients with primary SS ( 29 female ) were r and omly allocated to a treatment group . The mean + /- SD age of the patients receiving rituximab was 43 + /- 11 years and the disease duration was 63 + /- 50 months , while patients in the placebo group were age 43 + /- 17 years and had a disease duration of 67 + /- 63 months . In the rituximab group , significant improvements , in terms of the mean change from baseline compared with that in the placebo group , were found for the primary end point of the stimulated whole saliva flow rate ( P = 0.038 versus placebo ) and also for various laboratory parameters ( B cell and rheumatoid factor [ RF ] levels ) , subjective parameters ( Multidimensional Fatigue Inventory [ MFI ] scores and visual analog scale [ VAS ] scores for sicca symptoms ) , and extragl and ular manifestations . Moreover , in comparison with baseline values , rituximab treatment significantly improved the stimulated whole saliva flow rate ( P = 0.004 ) and several other variables ( e.g. , B cell and RF levels , unstimulated whole saliva flow rate , lacrimal gl and function on the lissamine green test , MFI scores , Short Form 36 health survey scores , and VAS scores for sicca symptoms ) . One patient in the rituximab group developed mild serum sickness-like disease . CONCLUSION These results indicate that rituximab is an effective and safe treatment strategy for patients with primary SS In the United States , approximately 35 % of adults with Systemic Lupus Erythematosus ( SLE ) have clinical evidence of nephritis at the time of diagnosis ; with an estimated total of 50–60 % developing nephritis during the first 10 years of disease [ 1–4 ] . The prevalence of nephritis is significantly higher in African Americans and Hispanics than in Caucasians , and is higher in men than in women . Renal damage is more likely to develop in non-Caucasian groups [ 2–4 ] . Overall survival in patients with SLE is approximately 95 % at 5 years after diagnosis and 92 % at 10 years [ 5 , 6 ] . The presence of lupus nephritis significantly reduces survival , to approximately 88 % at 10 years , with even lower survival in African Americans [ 5 , 6 ] . The American College of Rheumatology ( ACR ) last published guidelines for management of systemic lupus erythematosus ( SLE ) in 1999 [ 7 ] . That publication was design ed primarily for education of primary care physicians and recommended therapeutic and management approaches for many manifestations of SLE . Recommendations for management of lupus nephritis ( LN ) consisted of pulse glucocorticoids followed by high dose daily glucocorticoids in addition to an immunosuppressive medication , with cyclophosphamide viewed as the most effective immunosuppressive medication for diffuse proliferative glomerulonephritis . Mycophenolate mofetil was not yet in use for lupus nephritis and was not mentioned . Since that time , many clinical trials of glucocorticoids-plus-immunosuppressive interventions have been published , some of which are high quality prospect i ve trials , and some not only prospect i ve 
    Output:
    
Evidence supports the use of rituximab in moderate-to-severe refractory systemic lupus erythematosus , diffuse skin involvement in systemic sclerosis and systemic involvement in primary Sjögren syndrome .
In addition , there is a consensus about the use of rituximab in refractory myositis .
Conclusion : Rituximab is a treatment option in several SARDs .