A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction.
IgA nephropathy frequently leads to progressive CKD. Although interest surrounds use of immunosuppressive agents added to standard therapy, several recent studies have questioned efficacy of these agents. Depleting antibody-producing B cells potentially offers a new therapy. In this open label, multicenter study conducted over 1-year follow-up, we randomized 34 adult patients with biopsy-proven IgA nephropathy and proteinuria >1 g/d, maintained on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers with well controlled BP and eGFR<90 ml/min per 1.73 m2, to receive standard therapy or rituximab with standard therapy. Primary outcome measures included change in proteinuria and change in eGFR. Median baseline serum creatinine level (range) was 1.4 (0.8-2.4) mg/dl, and proteinuria was 2.1 (0.6-5.3) g/d. Treatment with rituximab depleted B cells and was well tolerated. eGFR did not change in either group. Rituximab did not alter the level of proteinuria compared with that at baseline or in the control group; three patients in each group had ≥50% reduction in level of proteinuria. Serum levels of galactose-deficient IgA1 or antibodies against galactose-deficient IgA1 did not change. In this trial, rituximab therapy did not significantly improve renal function or proteinuria assessed over 1 year. Although rituximab effectively depleted B cells, it failed to reduce serum levels of galactose-deficient IgA1 and antigalactose-deficient IgA1 antibodies. Lack of efficacy of rituximab, at least at this stage and severity of IgA nephropathy, may reflect a failure of rituximab to reduce levels of specific antibodies assigned salient pathogenetic roles in IgA nephropathy.
Division of Nephrology and Hypertension, Stanford University, Stanford, California.
Richard A
RA
Lafayette
Division of Nephrology and Hypertension, Columbia University Medical Center, New York, New York.
Pietro A
PA
Canetta
Division of Nephrology, Ohio State University, Columbus, Ohio.
Brad H
BH
Rovin
Division of Nephrology and Hypertension, Columbia University Medical Center, New York, New York.
Gerald B
GB
Appel
Departments of Microbiology and.
Jan
J
Novak
Division of Nephrology and Hypertension.
Karl A
KA
Nath
Department of Laboratory Medicine and Pathology, and.
Sanjeev
S
Sethi
Division of Nephrology, University of Tennessee, Chattanooga, Tennessee; and.
James A
JA
Tumlin
Division of Nephrology and Hypertension, Stanford University, Stanford, California.
Kshama
K
Mehta
Division of Nephrology and Hypertension.
Marie
M
Hogan
Division of Nephrology and Hypertension.
Stephen
S
Erickson
Departments of Microbiology and.|Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Bruce A
BA
Julian
Division of Nephrology and Hypertension.
Nelson
N
Leung
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Felicity T
FT
Enders
Departments of Microbiology and.
Rhubell
R
Brown
Departments of Microbiology and.|Department of Immunology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic.
Barbora
B
Knoppova
Departments of Microbiology and.
Stacy
S
Hall
Division of Nephrology and Hypertension, fervenza.fernando@mayo.edu.
Fernando C
FC
Fervenza
D000328:Adult; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D000069283:Rituximab / Q000627:therapeutic use*; D055815:Young Adult
D007155:Immunologic Factors; D000069283:Rituximab
IgA nephropathy; proteinuria; rituximab