I wonder how many lupus patients with severe disease he has treated - I would be thrilled to get down to twenty of prednisone - my "maintenance" dose is 25-30 mgs. daily and during a severe flare it goes up to 120-180 in divided doses daily. That's on top of IV solumedrol and cytoxan once a month and a dozen other misc. meds. My doctor doesn't bother re-testing my ANA anymore- it's always in the five digits and according to him ANA levels don't correlate with severity of disease, so he's generally more interested in the complement levels, sed rate and c-reactive protein. Your doctor is right that PML has occurred in other lupus patients who weren't treated with rituxan but had used other chemotherapy drugs, including cytoxan. PML occurs in about 5% of AIDS patients, but hasn't been seen that much in other patient groups except people on chemotherpay drugs. So it's still considered a rare complication. But only about 10,000 lupus patients have been treated with Rituxan so far, so I think the concern is more cases may show up as the drug is more widely used. I gathered from what I read about the two patients that they had not been treated with other cytotoxic drugs, which is why the deaths were linked to the Rituxan, And Rituxan is definitely linked to the cases of PML in the lymphoma patients.
Orencia (abatacept) is already available for treatment of moderate to severe rheumatoid arthritis and it is in Phase II development for lupus. So there is still a lot of testing ahead before they know if it will help lupus patients. It's a selective t-cell modulator so it can also cause severe immunosuppression. And since t-cell activation is only part of the picture with lupus, it might not help everyone with lupus. It has also been linked to the development of several types of cancer. So it will probably have about the same potential side effects as Rituxan, even though it is a slightly different class of drug. And right now it's very expensive, because it requires a initial dose of three separate infusions within the first four week period, then every four weeks thereafter. It doesn't have any cumulative or long-lasting benefit, so you have to take it every month to keep from relapsing. So hopefully they will find a way to make the benefits last longer without all the side effects.