title: Rituximab in severe lupus nephritis: early B-cell depletion affects long-term renal outcome.
abstract: 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.
authors.affiliation: Department of Nephrology, Assistance Publique-Hôpitaux Paris, Université Paris Descartes, Hôpital Necker, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Melander
authors.forename: Marion
authors.initials: M
authors.lastname: Sallée
authors.forename: Pierre
authors.initials: P
authors.lastname: Trolliet
authors.forename: Sophie
authors.initials: S
authors.lastname: Candon
authors.forename: Xavier
authors.initials: X
authors.lastname: Belenfant
authors.forename: Eric
authors.initials: E
authors.lastname: Daugas
authors.forename: Phillipe
authors.initials: P
authors.lastname: Rémy
authors.forename: Virginie
authors.initials: V
authors.lastname: Zarrouk
authors.forename: Evangéline
authors.initials: E
authors.lastname: Pillebout
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquot
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Boffa
authors.forename: Alexandre
authors.initials: A
authors.lastname: Karras
authors.forename: Virginie
authors.initials: V
authors.lastname: Masse
authors.forename: Philippe
authors.initials: P
authors.lastname: Lesavre
authors.forename: Caroline
authors.initials: C
authors.lastname: Elie
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brocheriou
authors.forename: Bertrand
authors.initials: B
authors.lastname: Knebelmann
authors.forename: Laure-Hélène
authors.initials: LH
authors.lastname: Noël
authors.forename: Fadi
authors.initials: F
authors.lastname: Fakhouri
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide