Rituximab treatment for glomerulonephritis in HCV-associated mixed cryoglobulinaemia: efficacy and safety in the absence of steroids.
OBJECTIVE
Rituximab, an anti-CD20 monoclonal antibody, has been used in lupus nephritis and membranous idiopathic nephropathy and has proved effective in non-renal manifestations of type II mixed cryoglobulinaemia (MC) syndrome. We investigated the possible efficacy and safety of rituximab in the treatment of cryoglobulinaemic nephritis.


METHODS
Five patients with active, biopsy-proven, glomerulonephritis in hepatitis C virus (HCV)-related type II MC syndrome were treated with four weekly infusions of rituximab (375 mg/m2) in monotherapy, without steroids whenever possible. Rituximab was the first-line therapy in three cases.


RESULTS
A rapid and sustained renal response was observed in all patients, in one of them without retreatment up to the last follow-up (month 21+). Renal biopsy was repeated after 6 months in one patient and histopathological improvement was documented. Three patients relapsed, at months +5, +7 and +12 of follow-up, respectively. Two of them were then retreated with rituximab and again presented a rapid improvement in renal function. Maintenance therapy with rituximab was performed in two patients: nephritis remission was maintained in both. Fc-gamma receptor 3a (FcgammaRIIIa) genotype characterization was consistent with the clinical response observed. Rituximab also proved effective against other active MC manifestations, when present. No major side-effects occurred and steroids were not required in the follow-up.


CONCLUSIONS
Rituximab may provide effective and safe therapy in type II MC-related glomerulonephritis, possibly as first-line therapy, avoiding steroids and hazardous immunosuppressive treatment.
Quartuccio
L
L
Rheumatology Clinic, University of Udine, Piazzale Santa Maria della Misericordia 1, 33100 Udine, Italy.
Soardo
G
G
Romano
G
G
Zaja
F
F
Scott
C A
CA
De Marchi
G
G
Fabris
M
M
Ferraccioli
G
G
De Vita
S
S
D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003449:Cryoglobulinemia / Q000150:complications*; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D017452:Receptors, IgG / Q000235:genetics; D012008:Recurrence; D000069283:Rituximab; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; C496124:FCGR3A protein, human; D005938:Glucocorticoids; D017452:Receptors, IgG; D000069283:Rituximab