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Rituximab is an effective treatment for lupus nephritis and allows a reduction in maintenance steroids.

Abstract

BACKGROUND

Lupus nephritis is a life-threatening complication of SLE. Treatment regimes include steroids and cyclophosphamide, both associated with significant morbidity. Newer regimes include mycophenolate mofetil (MMF). We report our outcomes in a prospectively monitored cohort of patients receiving our new standard treatment protocol, comprising rituximab induction therapy and MMF maintenance in patients already taking maintenance immunosuppression for SLE who developed lupus nephritis. We then attempted steroid reduction/withdrawal.

METHODS

Patients with class III/IV/V lupus nephritis were included. All patients were on steroids prior to the development of lupus nephritis. Eighteen patients have reached at least 1 year follow-up. These patients received rituximab induction therapy and MMF maintenance therapy. Steroid reduction/withdrawal was guided by clinical response.

RESULTS

Fourteen of 18 (78%) patients achieved complete or partial remission with a sustained response of 12/18 (67%) at 1 year, with 2 patients having a relapse of proteinuria. Four patients did not respond. There was a significant decrease in proteinuria from a mean protein:creatinine ratio (PCR) of 325 mg/mmol at presentation to 132 mg/mmol at 1 year (P = 0.004). Serum albumin significantly increased from a mean of 29 g/L at presentation to 34 g/L at 1 year (P = 0.001). The complication rate was low with no severe infections. Following treatment with rituximab, 6 patients stopped prednisolone, 6 patients reduced their maintenance dose and 6 patients remained on the same dose (maximum 10 mg).

CONCLUSION

This data demonstrates the efficacy of a rituximab and MMF based regime in the treatment of lupus nephritis, allowing a reduction or total withdrawal of corticosteroids.

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  • Authors+Show Affiliations

    ,

    Imperial College Kidney and Transplant Institute, West London Renal and Transplant Centre, Hammersmith Hospital, London UK. ruthjpepper@doctors.net.uk

    , , , , , ,

    Source

    MeSH

    Adrenal Cortex Hormones
    Adult
    Aged
    Antibodies, Monoclonal
    Antibodies, Monoclonal, Murine-Derived
    Female
    Humans
    Immunologic Factors
    Lupus Nephritis
    Male
    Middle Aged
    Prospective Studies
    Rituximab
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19617257

    Citation

    Pepper, Ruth, et al. "Rituximab Is an Effective Treatment for Lupus Nephritis and Allows a Reduction in Maintenance Steroids." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 24, no. 12, 2009, pp. 3717-23.
    Pepper R, Griffith M, Kirwan C, et al. Rituximab is an effective treatment for lupus nephritis and allows a reduction in maintenance steroids. Nephrol Dial Transplant. 2009;24(12):3717-23.
    Pepper, R., Griffith, M., Kirwan, C., Levy, J., Taube, D., Pusey, C., ... Cairns, T. (2009). Rituximab is an effective treatment for lupus nephritis and allows a reduction in maintenance steroids. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 24(12), pp. 3717-23. doi:10.1093/ndt/gfp336.
    Pepper R, et al. Rituximab Is an Effective Treatment for Lupus Nephritis and Allows a Reduction in Maintenance Steroids. Nephrol Dial Transplant. 2009;24(12):3717-23. PubMed PMID: 19617257.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Rituximab is an effective treatment for lupus nephritis and allows a reduction in maintenance steroids. AU - Pepper,Ruth, AU - Griffith,Megan, AU - Kirwan,Chris, AU - Levy,Jeremy, AU - Taube,David, AU - Pusey,Charles, AU - Lightstone,Liz, AU - Cairns,Tom, Y1 - 2009/07/17/ PY - 2009/7/21/entrez PY - 2009/7/21/pubmed PY - 2010/2/3/medline SP - 3717 EP - 23 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 24 IS - 12 N2 - BACKGROUND: Lupus nephritis is a life-threatening complication of SLE. Treatment regimes include steroids and cyclophosphamide, both associated with significant morbidity. Newer regimes include mycophenolate mofetil (MMF). We report our outcomes in a prospectively monitored cohort of patients receiving our new standard treatment protocol, comprising rituximab induction therapy and MMF maintenance in patients already taking maintenance immunosuppression for SLE who developed lupus nephritis. We then attempted steroid reduction/withdrawal. METHODS: Patients with class III/IV/V lupus nephritis were included. All patients were on steroids prior to the development of lupus nephritis. Eighteen patients have reached at least 1 year follow-up. These patients received rituximab induction therapy and MMF maintenance therapy. Steroid reduction/withdrawal was guided by clinical response. RESULTS: Fourteen of 18 (78%) patients achieved complete or partial remission with a sustained response of 12/18 (67%) at 1 year, with 2 patients having a relapse of proteinuria. Four patients did not respond. There was a significant decrease in proteinuria from a mean protein:creatinine ratio (PCR) of 325 mg/mmol at presentation to 132 mg/mmol at 1 year (P = 0.004). Serum albumin significantly increased from a mean of 29 g/L at presentation to 34 g/L at 1 year (P = 0.001). The complication rate was low with no severe infections. Following treatment with rituximab, 6 patients stopped prednisolone, 6 patients reduced their maintenance dose and 6 patients remained on the same dose (maximum 10 mg). CONCLUSION: This data demonstrates the efficacy of a rituximab and MMF based regime in the treatment of lupus nephritis, allowing a reduction or total withdrawal of corticosteroids. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/19617257/Rituximab_is_an_effective_treatment_for_lupus_nephritis_and_allows_a_reduction_in_maintenance_steroids_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfp336 DB - PRIME DP - Unbound Medicine ER -