title: Biopsy-verified response of severe lupus nephritis to treatment with rituximab (anti-CD20 monoclonal antibody) plus cyclophosphamide after biopsy-documented failure to respond to cyclophosphamide alone.
abstract: BACKGROUND
  The monoclonal anti-B cell antibody rituximab (Rituxin, Mabthera) may be of benefit in antibody-driven diseases, including systemic lupus erythematosus (SLE) nephritis.
  
  
  METHODS
  Two female patients with biopsy-confirmed severe and active SLE nephritis despite treatment with cyclophosphamide (CyX) were given four rituximab infusions plus two additional CyX infusions.
  
  
  RESULTS
  Both patients tolerated the treatment well and SLE activity improved. On repeat kidney biopsy after the combined treatment, Patient 1 showed a profound reduction of nephritis activity, and she was maintained on low-dose prednisolone only. A repeat biopsy after 1 year confirmed the sustained reduction of lupus nephritis activity. In Patient 2, rebiopsy after combined treatment also showed a significant reduction in disease activity.
  
  
  CONCLUSIONS
  These cases provide histopathological documentation of a significant treatment benefit from rituximab plus CyX in two patients refractory to CyX alone. This combination is being explored further as salvage therapy for such CyX-resistant patients.
authors.affiliation: Department of Rheumatology, Karolinska Hospital, Stockholm, Sweden. ronald.vanvollenhoven@ks.se
authors.forename: R F
authors.initials: RF
authors.lastname: van Vollenhoven
authors.forename: I
authors.initials: I
authors.lastname: Gunnarsson
authors.forename: E
authors.initials: E
authors.lastname: Welin-Henriksson
authors.forename: B
authors.initials: B
authors.lastname: Sundelin
authors.forename: A
authors.initials: A
authors.lastname: Osterborg
authors.forename: S H
authors.initials: SH
authors.lastname: Jacobson
authors.forename: L
authors.initials: L
authors.lastname: Klareskog
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001707:Biopsy, Needle; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007677:Kidney Function Tests; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000473:pathology*; D018570:Risk Assessment; D000069283:Rituximab; D012720:Severity of Illness Index; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D003520:Cyclophosphamide