Homozygous FCGR3A-158F mutation is associated with delayed B-cell depletion following rituximab but with preserved efficacy in a patient with refractory lupus nephritis.
Rituximab (RTX), an anti-CD20 monoclonal antibody, has shown promising results in a small group of systemic lupus erythematosus (SLE) patients treated for lupus nephritis (LN). However, such observations were not confirmed in the double-blind LUNAR study. Accordingly, the factors associated with the clinical response remain to be characterized. We report the case of a young woman with known LN successfully re-treated with RTX and steroids and homozygous for the low-affinity FCG3RA 158F genotype. Although B-cell depletion was delayed, complete remission with anti-DNA antibody negativity and proteinuria normalization were maintained for 5 years. The implications for disease pathogenesis and clinical monitoring are discussed.
EA2216 Immunology and Pathology, European University of Brittany, Brest, France; Laboratory of Immunology, Brest University Medical School, CHRU Morvan,Brest, France; Unit of Nephrology, Brest University Medical School, CHRU Cavale Blanche, Brest, France.
Guillaume
G
Seret
Unit of Nephrology , Brest University Medical School, CHRU Cavale Blanche , Brest , France.
Catherine
C
Hanrotel
EA2216 Immunology and Pathology, European University of Brittany, Brest, France; Laboratory of Immunology, Brest University Medical School, CHRU Morvan,Brest, France.
Boutahar
B
Bendaoud
EA2216 Immunology and Pathology, European University of Brittany, Brest, France; Unit of Nephrology, Brest University Medical School, CHRU Cavale Blanche, Brest, France.
Yannick
Y
Le Meur
EA2216 Immunology and Pathology, European University of Brittany, Brest, France; Laboratory of Immunology, Brest University Medical School, CHRU Morvan,Brest, France.
Yves
Y
Renaudineau
B-cell depletion; FCGR3A; lupus nephritis; rituximab