title: Rituximab vs mycophenolate and vs cyclophosphamide pulses for induction therapy of active lupus nephritis: a clinical observational study.
abstract: OBJECTIVE
  We report the first comparison between rituximab (RTX) and either MMF or CYC pulses in the treatment of active LN.
  
  
  METHODS
  Fifty-four patients with active LN received three methylprednisolone pulses for 3 consecutive days followed by oral prednisone and RTX 1 g at days 3 and 18 (17 patients) or MMF 2-2.5 g/day (17 patients) or six CYC pulses (0.5 g every fortnight) (20 patients). At 4 months MMF, AZA or ciclosporin were associated to prednisone as a consolidation/maintenance therapy in all groups. The outcomes of the three groups were compared at 3 and 12 months.
  
  
  RESULTS
  Patients in the RTX group were older, had a longer duration of SLE and LN, had more renal flares, had higher activity and had higher chronicity indexes at renal biopsy than the other two groups. Four patients in each group had acute renal dysfunction and ∼50% had nephrotic syndrome. At 3 months, proteinuria was reduced by 50% in 58.8% of patients on RTX, in 64.7% on MMF and in 63.1% on CYC. At 12 months, complete remission was present in 70.6% of patients on RTX, in 52.9% on MMF, and in 65% on CYC. Partial remission was reached in 29.4% on RTX, 41.2% on MMF, and 25% on CYC.
  
  
  CONCLUSIONS
  RTX seems to be at least as effective as MMF and CYC pulses in inducing remission. Considering that patients treated with RTX had more negative renal prognostic factors, this drug should be considered a viable alternative for the treatment of active LN.
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy. gmoroni@policlinico.mi.it.
authors: Gabriella
authors: G
authors: Moroni
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors: Francesca
authors: F
authors: Raffiotta
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors: Barbara
authors: B
authors: Trezzi
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors: Elisa
authors: E
authors: Giglio
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors: Nicoletta
authors: N
authors: Mezzina
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors: Nicoletta
authors: N
authors: Del Papa
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors: Pierluigi
authors: P
authors: Meroni
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors: Piergiorgio
authors: P
authors: Messa
authors: Divisione di Nefrologia & Dialisi, IRCCS Fondazione Ca' Granda, Ospedale Maggiore, Mangiagalli, Regina Elena, Divisone di Nefrologia e Immunologia clinica, Ospedale San Carlo Borromeo, Dipartimento di Reumatologia, Unita' Operativa di Day Hospital, Istituto G. Pini and Dipartimento di Reumatologia, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors: Alberto Renato
authors: AR
authors: Sinico
mesh_terms: D000284:Administration, Oral; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069283:Rituximab; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D009173:Mycophenolic Acid
keywords: cyclophosphamide pulse therapy; lupus nephritis; mycophenolate therapy; rituximab therapy; systemic lupus erythematosus