Catastrophic antiphospholipid syndrome (CAPS) is a lethal disease that occurs suddenly and progresses to multi-organ failure. We present a case of CAPS successfully treated with the rituximab biosimilar CT-P10. A 38-year-old man was referred with a sustained fever and unexplained elevated creatinine levels. Cardiac arrest by ventricular fibrillation occurred upon arrival at the hospital. We diagnosed probable CAPS because of coronary thrombus, renal impairment, suspected diffuse alveolar hemorrhage, and positive anticardiolipin antibody immunoglobulin G. We performed percutaneous coronary intervention for the cardiac arrest, and treated him with extracorporeal membrane oxygenation, mechanical ventilation, and continuous renal replacement therapy. When CAPS was diagnosed, we administered CT-P10 after administering high-dose glucocorticoid. Our case suggests that the use of a rituximab biosimilar is economically efficient in the treatment of CAPS, as in other rheumatic diseases. The patient was cured without recurrence at the 2-year follow-up.

1. Espinosa, G, Rodríguez-Pintó, I, Cervera, R. Catastrophic antiphospholipid syndrome: an update. Panminerva Med 2017; 59: 254–268.
Google Scholar | Crossref | Medline2. Erkan, D, Asherson, RA, Espinosa, G, et al. Long term outcome of catastrophic antiphospholipid syndrome survivors. Ann Rheum Dis 2003; 62: 530–533.
Google Scholar | Crossref | Medline | ISI3. Asherson, RA, Espinosa, G, Menahem, S, et al. Relapsing catastrophic antiphospholipid syndrome: report of three cases. Semin Arthritis Rheum 2008; 37: 366–372.
Google Scholar | Crossref | Medline | ISI4. Kazzaz, NM, McCune, WJ, Knight, JS. Treatment of catastrophic antiphospholipid syndrome. Curr Opin Rheumatol 2016; 28: 218–227.
Google Scholar | Crossref | Medline | ISI5. Meroni, PL, Borghi, MO, Raschi, E, et al. Pathogenesis of antiphospholipid syndrome: understanding the antibodies. Nat Rev Rheumatol 2011; 7: 330–339.
Google Scholar | Crossref | Medline | ISI6. Chaturvedi, S, Braunstein, EM, Yuan, X, et al. Complement activity and complement regulatory gene mutations are associated with thrombosis in APS and CAPS. Blood 2020; 135: 239–251.
Google Scholar | Crossref | Medline7. Berman, H, Rodríguez-Pintó, I, Cervera, R, et al. Rituximab use in the catastrophic antiphospholipid syndrome: descriptive analysis of the CAPS registry patients receiving rituximab. Autoimmun Rev 2013; 12: 1085–1090.
Google Scholar | Crossref | Medline | ISI8. Wang, C-R, Liu, M-F. Rituximab usage in systemic lupus erythematosus-associated antiphospholipid syndrome: a single-center experience. Semin Arthritis Rheum 2016; 46: 102–108.
Google Scholar | Crossref | Medline | ISI9. Rymarz, A, Niemczyk, S. The complex treatment including rituximab in the management of catastrophic antiphospholid syndrome with renal involvement. BMC Nephrol 2018; 19: 132.
Google Scholar | Crossref | Medline10. Cavalli, E, Bramanti, A, Ciurleo, R, et al. Entangling COVID-19 associated thrombosis into a secondary antiphospholipid antibody syndrome: diagnostic and therapeutic perspectives (Review). Int J Mol Med 2020; 46: 903–912.
Google Scholar | Crossref | Medline11. Park, W, Božić-Majstorović, L, Milakovic, D, et al. Comparison of biosimilar CT-P10 and innovator rituximab in patients with rheumatoid arthritis: a randomized controlled Phase 3 trial. MAbs 2018; 10: 934–943.
Google Scholar | Crossref | Medline12. Moore, C . Biosimilar monoclonal antibodies (mAbs) in oncology. Br J Nurs 2017; 26: S26–S32.
Google Scholar | Crossref | Medline13. Campochiaro, C, De Luca, G, Lazzaroni, MG, et al. Safety and efficacy of rituximab biosimilar (CT-P10) in systemic sclerosis: an Italian multicentre study. Rheumatology 2020; 0: 1–6.
Google Scholar14. Bhatt, V . Current market and regulatory landscape of biosimilars. Am J Manag Care 2018; 24: S451–S6.
Google Scholar | Medline15. Soldatov, AA, Avdeeva, JI, Kryuchkov, NA, et al. Safety concerns of biosimilar hormone products. Curr Med Res Opin 2019; 35: 1003–1009.
Google Scholar | Crossref | Medline