title: Late response to rituximab in a dialysis patient with severe lupus nephritis.
abstract: Although recently completed controlled trials failed to demonstrate a significant effect of rituximab on the clinical outcome in non-renal and renal lupus, there is growing evidence from case reports and open-label trials that the use of this medication is successful in certain subgroups of patients including refractory cases and helps in reducing the dose of steroids. We present a 26-year-old female who failed to respond to a long-course treatment with prednisolone, cyclophosphamide, mycophenolate mofetil and azathioprine and who went on to develop end-stage renal disease requiring commencement of regular maintenance hemodialysis. Ten days before starting dialysis, she was given rituximab, and a second dose was given 17 days after starting dialysis. After 7 months on dialysis, the patient began to regain kidney function and is now off dialysis for 11 months. To the best of our knowledge, this is the first case report of a lupus patient on dialysis treated with rituximab in whom dialysis could be stopped and who remained off this therapy up till now, after an observation period of 1 year.
authors.affiliation: Department of Nephrology, Al Hada Armed Forces Hospital, Taif, Saudi Arabia. magdihussein@hotmail.com
authors.forename: Magdi M
authors.initials: MM
authors.lastname: Hussein
authors.forename: Jaap M
authors.initials: JM
authors.lastname: Mooij
authors.forename: Najla
authors.initials: N
authors.lastname: Al Malki
authors.forename: Tarek M
authors.initials: TM
authors.lastname: Demerdash
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy*; D008775:Methylprednisolone / Q000008:administration & dosage; D020127:Recovery of Function; D006435:Renal Dialysis; D000069283:Rituximab; D017211:Treatment Failure
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D008775:Methylprednisolone