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


METHODS
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.


CONCLUSIONS
Rituximab is an interesting therapeutic option in relapsing or refractory lupus nephritis when early B cell depletion is obtained.
Melander
Catherine
C
Department of Nephrology, Assistance Publique-Hôpitaux Paris, Université Paris Descartes, Hôpital Necker, Paris, France.
Sallée
Marion
M
Trolliet
Pierre
P
Candon
Sophie
S
Belenfant
Xavier
X
Daugas
Eric
E
Rémy
Phillipe
P
Zarrouk
Virginie
V
Pillebout
Evangéline
E
Jacquot
Christian
C
Boffa
Jean-Jacques
JJ
Karras
Alexandre
A
Masse
Virginie
V
Lesavre
Philippe
P
Elie
Caroline
C
Brocheriou
Isabelle
I
Knebelmann
Bertrand
B
Noël
Laure-Hélène
LH
Fakhouri
Fadi
F
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001402:B-Lymphocytes / Q000187:drug effects* / Q000276:immunology; D044383:Black People; D003520:Cyclophosphamide / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy* / Q000208:ethnology / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D034141:Hypoalbuminemia / Q000188:drug therapy / Q000276:immunology; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007677:Kidney Function Tests; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000208:ethnology / Q000276:immunology / Q000503:physiopathology; D008212:Lymphocyte Depletion / Q000379:methods*; D008297:Male; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide