Background Rituximab, a monoclonal antibody against the CD20 receptor of the lymphocyte membrane, is increasingly used off-label in autoimmune kidney disease for its ability to deplete B cells.
Purpose To evaluate the effectiveness and safety of treatment with rituximab in patients with autoimmune kidney disease.
Material and methods Ambispective observational study with patients diagnosed with autoimmune kidney disease treated with rituximab, in a tertiary hospital, between January 2011 and December 2014. For each patient, the following variables were recorded: sex, age, biochemical parameters before, and 6 and 12 months after treatment with rituximab; and adverse reactions to treatment. Demographic, clinical and laboratory data were collected from the patient medical history and from the dispensing record of the pharmacy service. The criteria for effectiveness were reduction of proteinuria and increase in serum albumin with creatinine levels remaining stable for 12 months after treatment. Statistical analysis consisted of a Student’s t-Fisher test for paired data.
Results 39 patients were included, with a mean age of 60 years (31–85), of whom 18 were women (46%). 34 of 39 patients received two doses of rituximab 1000 mg separated by 15 days. 4 patients did not receive the full treatment, due to allergy to rituximab (3/4) and an episode of fainting (1/4) at the first administration.
Pretreatment analytical data were (mean (SD)): proteinuria 361.87 mg/dL (270.01), albumin 3.16 g/dL (0,63), creatinine 1.99 mg/mL (1.44), urea 74.35 mg/dL (30.23), glomerular filtration rate (GFR) 46.69 mL/min (31.31), glucose 102.45 mg/dL (23.97) and cholesterol 238.75 mg/dL (91.76).
At 6 months: proteinuria 244.16 mg/dL (251.32), albumin 3.76 g/dL (0.68), creatinine 2.20 mg/mL (2,01), urea 77.15 mg/dL (39.17), GFR 50 mL/min (34.75), glucose 92.30 mg/dL (18.82) and cholesterol 220.85 mg/dL (57.31).
At 12 months: proteinuria 144.59 mg/dL (170.84), albumin 3.84 g/dL (0.54), creatinine 2.28 mg/mL (2.26), urea 74.1 mg/dL (41.02), GFR 50.4 mL/min (34.09), glucose 98.20 mg/dL (17.58) and cholesterol 206.35 mg/dL (53.24).
Proteinuria decreased by 22%, albumin increased by 60% and creatinine was not significantly different after 12 months of treatment with rituximab.
Conclusion Rituximab significantly reduces proteinuria and increases plasma albumin, indicative of a reduction in acute kidney injury. In addition, creatinine levels remained constant, evidence of the maintenance of renal function. 10% of patients had allergic reactions to rituximab and had to stop treatment.
No conflict of interest.
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