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Rituximab in severe lupus nephritis: early B-cell depletion affects long-term renal outcome.

Abstract

BACKGROUND AND OBJECTIVES

Standard treatment for lupus nephritis, including corticosteroids and cyclophosphamide, is efficient but is still associated with refractory or relapsing disease, or severe deleterious effects. Rituximab, a monoclonal chimeric anti-B cell antibody, is increasingly used in patients with lupus nephritis, but reported series were small and had a short follow-up.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

The authors analyzed clinical and histologic data of 20 patients who were treated with rituximab for lupus nephritis and followed up for at least 12 mo.

RESULTS

Nineteen women and one man received rituximab as induction treatment for an active class IV (15 cases) or class V (5 cases) lupus nephritis. Rituximab was given for lupus nephritis refractory to standard treatment (12 cases), for relapsing disease (6 cases), or as first-line treatment (2 cases). Three patients received cyclophosphamide concomitantly with rituximab. Ten received new injections of rituximab as maintenance therapy. Side effects included mainly five infections and four moderate neutropenias. After a median follow-up of 22 mo, complete or partial renal remission was obtained in 12 patients (60%). Lupus nephritis relapsed in one patient, who responded to a new course of rituximab. The achievement of B cell depletion 1 mo after rituximab, which negatively correlated with black ethnicity and hypoalbuminemia, was strongly associated with renal response. Rapidly progressive glomerulonephritis did not respond to rituximab.

CONCLUSION

Rituximab is an interesting therapeutic option in relapsing or refractory lupus nephritis when early B cell depletion is obtained.

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  • Authors+Show Affiliations

    ,

    Department of Nephrology, Assistance Publique-Hôpitaux Paris, Université Paris Descartes, Hôpital Necker, Paris, France.

    , , , , , , , , , , , , , , , , ,

    Source

    MeSH

    African Continental Ancestry Group
    Antibodies, Monoclonal
    Antibodies, Monoclonal, Murine-Derived
    B-Lymphocytes
    Cyclophosphamide
    Disease Progression
    Drug Therapy, Combination
    Female
    France
    Glomerulonephritis, Membranous
    Humans
    Hypoalbuminemia
    Immunologic Factors
    Immunosuppressive Agents
    Kidney
    Kidney Function Tests
    Lupus Nephritis
    Lymphocyte Depletion
    Male
    Patient Selection
    Recurrence
    Retrospective Studies
    Rituximab
    Severity of Illness Index
    Time Factors
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Multicenter Study

    Language

    eng

    PubMed ID

    19261822

    Citation

    Melander, Catherine, et al. "Rituximab in Severe Lupus Nephritis: Early B-cell Depletion Affects Long-term Renal Outcome." Clinical Journal of the American Society of Nephrology : CJASN, vol. 4, no. 3, 2009, pp. 579-87.
    Melander C, Sallée M, Trolliet P, et al. Rituximab in severe lupus nephritis: early B-cell depletion affects long-term renal outcome. Clin J Am Soc Nephrol. 2009;4(3):579-87.
    Melander, C., Sallée, M., Trolliet, P., Candon, S., Belenfant, X., Daugas, E., ... Fakhouri, F. (2009). Rituximab in severe lupus nephritis: early B-cell depletion affects long-term renal outcome. Clinical Journal of the American Society of Nephrology : CJASN, 4(3), pp. 579-87. doi:10.2215/CJN.04030808.
    Melander C, et al. Rituximab in Severe Lupus Nephritis: Early B-cell Depletion Affects Long-term Renal Outcome. Clin J Am Soc Nephrol. 2009;4(3):579-87. PubMed PMID: 19261822.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Rituximab in severe lupus nephritis: early B-cell depletion affects long-term renal outcome. AU - Melander,Catherine, AU - Sallée,Marion, AU - Trolliet,Pierre, AU - Candon,Sophie, AU - Belenfant,Xavier, AU - Daugas,Eric, AU - Rémy,Phillipe, AU - Zarrouk,Virginie, AU - Pillebout,Evangéline, AU - Jacquot,Christian, AU - Boffa,Jean-Jacques, AU - Karras,Alexandre, AU - Masse,Virginie, AU - Lesavre,Philippe, AU - Elie,Caroline, AU - Brocheriou,Isabelle, AU - Knebelmann,Bertrand, AU - Noël,Laure-Hélène, AU - Fakhouri,Fadi, Y1 - 2009/03/04/ PY - 2009/3/6/entrez PY - 2009/3/6/pubmed PY - 2009/6/3/medline SP - 579 EP - 87 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 4 IS - 3 N2 - BACKGROUND AND OBJECTIVES: Standard treatment for lupus nephritis, including corticosteroids and cyclophosphamide, is efficient but is still associated with refractory or relapsing disease, or severe deleterious effects. Rituximab, a monoclonal chimeric anti-B cell antibody, is increasingly used in patients with lupus nephritis, but reported series were small and had a short follow-up. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The authors analyzed clinical and histologic data of 20 patients who were treated with rituximab for lupus nephritis and followed up for at least 12 mo. RESULTS: Nineteen women and one man received rituximab as induction treatment for an active class IV (15 cases) or class V (5 cases) lupus nephritis. Rituximab was given for lupus nephritis refractory to standard treatment (12 cases), for relapsing disease (6 cases), or as first-line treatment (2 cases). Three patients received cyclophosphamide concomitantly with rituximab. Ten received new injections of rituximab as maintenance therapy. Side effects included mainly five infections and four moderate neutropenias. After a median follow-up of 22 mo, complete or partial renal remission was obtained in 12 patients (60%). Lupus nephritis relapsed in one patient, who responded to a new course of rituximab. The achievement of B cell depletion 1 mo after rituximab, which negatively correlated with black ethnicity and hypoalbuminemia, was strongly associated with renal response. Rapidly progressive glomerulonephritis did not respond to rituximab. CONCLUSION: Rituximab is an interesting therapeutic option in relapsing or refractory lupus nephritis when early B cell depletion is obtained. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/19261822/Rituximab_in_severe_lupus_nephritis:_early_B_cell_depletion_affects_long_term_renal_outcome_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=19261822 DB - PRIME DP - Unbound Medicine ER -