Background Some autoimmune diseases can develop renal manifestations that are refractory to conventional drug treatment, making haemodialysis the only therapeutic alternative.
Purpose To analyse the response rate to rituximab as third-line treatment in patients with renal manifestations secondary to autoimmune diseases.
Materials and methods Retrospective, observational study.
Inclusion criteria: all patients with renal manifestations secondary to autoimmune disease treated with rituximab.
Exclusion criteria: those treated with rituximab in acute or chronic renal transplant rejection. Data collected: patient age, gender, diagnosis, rituximab regimen and response (complete remission, partial or no response). The response was measured up to about 3 months of treatment.
Results 27 patients were included: 18 women and 9 men. Mean age was 36 ± 14 and 34 ± 13 years old, respectively. Diagnoses were with lupus nephritis in 11 (41%), membranous nephropathy in 7 (26%), ANCA-positive vasculitis in 3 (11%), mesangiocapillary glomerulonephritis in 2 (7%), minimal change disease in 2 (7%), Wegener’s granulomatosis in 1 (4%) and focal segmental glomerulosclerosis in 1(4%). 16 patients received the standard cycle of rituximab (375 mg/m2 weekly for 4 doses), 2 patients received 2 cycles, 1 received 4 cycles, 1 received 6 cycles and 1 patient received only 2 weekly doses. Response was complete in 11 (41%) patients (7/11 in lupus nephritis, 2/7 in membranous nephropathy, 1/1 in Wegener’s granulomatosis and 1/1 in mesangiocapillary glomerulonephritis), partial response in 11 (41%) and no response in 5 (24%) (2/3 ANCA-positive vasculitis).
Conclusions Patients with renal manifestations secondary to autoimmune disease treated with rituximab may get a complete or partial response. This has some advantages in the therapeutic approach, allowing doses of other immunosuppressive agents (steroids, tacrolimus, etc.) to be reduced or the relapse of nephrotic syndrome to be delayed. The autoimmune disease that responded least well to rituximab was ANCA-positive vasculitis.
No conflict of interest.
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