title: Long-term follow-up in lupus nephritis patients treated with rituximab--clinical and histopathological response.
abstract: OBJECTIVE
  To investigate the long-term clinical, histological and serological affects of B-cell-depleting therapy (BCDT) in patients with LN refractory to conventional treatment.
  
  
  METHODS
  Twenty-five patients, followed for a mean time of 36 months (9-95 months), were included. Renal disease activity was evaluated with the BILAG index and renal response was determined according to the LN European consensus statement. Renal biopsies were performed for histological evaluation at baseline and follow-up.
  
  
  RESULTS
  Partial response (PR) or complete renal response (CR) was observed in 22 of 25 after a median of 12 months. Sixteen patients achieved CR after a median of 24 months. Six patients experienced a renal relapse. Proteinuria decreased significantly (P = 0.0002) from baseline to 36 months. A noteworthy histological improvement was seen in nearly all patients with a significant reduction in activity index (P = 0.01). Longer depletion time and low baseline values of IgM were indicative of achieving clinical remission during the first year after treatment (P = 0.03 and P = 0.04, respectively).
  
  
  CONCLUSIONS
  In therapy-resistant LN, BCDT induced clinical and histological improvements in the majority of patients. Transition from PR to CR was mainly seen during the second year of follow-up. Patients with longer depletion time and low baseline levels of IgM were more likely to gain a faster remission, suggesting that the clinical benefit may be linked to suppression of autoreactive plasmablasts. Although formal evidence of BCDT in LN is lacking, our data may provide guidance to clinicians considering therapeutic options in patients with refractory LN.
authors.affiliation: Department of Medicine, Rheumatology Unit, Landspitali University Hospital, 108, Reykjavík, Iceland. torunnjo@landspitali.is
authors.forename: Thórunn
authors.initials: T
authors.lastname: Jónsdóttir
authors.forename: Agneta
authors.initials: A
authors.lastname: Zickert
authors.forename: Birgitta
authors.initials: B
authors.lastname: Sundelin
authors.forename: Elisabet W
authors.initials: EW
authors.lastname: Henriksson
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
authors.forename: Iva
authors.initials: I
authors.lastname: Gunnarsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D001707:Biopsy, Needle; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007150:Immunohistochemistry; D007262:Infusions, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000473:pathology; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D000069283:Rituximab; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D005938:Glucocorticoids; D000069283:Rituximab; D003520:Cyclophosphamide