Rituximab alone as induction therapy for membranous lupus nephritis: A multicenter retrospective study.

Medicine (Baltimore)

Department of Nephrology, Hôpital Bichat, AP-HP, Université Paris Diderot, DHU FIRE, INSERM U1149, Paris Department of Nephrology, Hôpital Henri Duffaut, Avignon Department of Nephrology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes Department of Nephrology, Hôpital de la Pitié Salpêtrière, AP-HP, Paris, France; INSERM CESP team 5, Villejuif Department of Medicine, Hôpital François Quesnay, Mantes-la-Jolie Department of Nephrology, CHU de Point-à Pitre, Guadeloupe Department of Internal Medicine,Hôpital Cochin, APHP Department of Nephrology, Hôpital Européen Georges-Pompidou, APHP, Paris, France.

Published: July 2017

The optimal treatment for pure membranous lupus nephritis (MLN) remains undetermined. Rituximab constitutes a promising therapeutic option for lupus nephritis and is currently being evaluated for use in idiopathic membranous nephritis. We retrospectively analysed the efficacy and tolerance of rituximab as a monotherapy in the induction treatment of pure MLN.We retrospectively investigated SLE patients with biopsy-proven pure class V lupus nephritis presenting with a protein-to-creatinine ratio of at least 2 g/g and treated with rituximab as monotherapy. A background low dose of corticosteroids (≤20 mg/day) was allowed, as was hydroxychloroquine; higher doses of steroids and/or immunosuppressive drugs fell under the exclusion criteria. Remission status was evaluated at baseline and 6, 12, and 24 months after rituximab.The study included 15 patients (13 women, median age 37 years, 27% with extra-renal manifestations, median SLE duration 1.5 years). The median protein-to-creatinine ratio was 4.9 g/g, 80% of the patients had nephrotic-range proteinuria, the median serum albumin was 24 g/L, the median serum creatinine was 0.7 mg/dL, and the median eGFR was 122 mL/min/1.73 m. The median follow-up was 29 months (6-112 months). Treatment failure occurred in 2 patients. However, remission was recorded in the remaining 13 (87%, complete remission in 8 patients) with a median time to remission of 5 months. Median proteinuria decreased from 4.9 g/g to 0.16 g/g at month 12 and to 0.11 g/g at month 24. Median serum albumin increased to 36.5 g/L at month 24, and all patients had serum albumin levels greater than 30 g/L at month 12. Renal function remained stable in all patients. Relapse of proteinuria was recorded in 3 patients (at 12, 29, and 34 months). No patients experienced serious adverse events.Rituximab as monotherapy may represent an effective treatment for pure MLN with an excellent tolerance profile.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5502178PMC
http://dx.doi.org/10.1097/MD.0000000000007429DOI Listing

Publication Analysis

Top Keywords

lupus nephritis
16
treatment pure
12
median serum
12
serum albumin
12
median
10
patients
9
membranous lupus
8
rituximab monotherapy
8
protein-to-creatinine ratio
8
nephritis
5

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!