RESEARCH - Rituximab treatment for glomerulonephritis in HCV-associated mixed cryoglobulinaemia

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Rheumatology (Oxford). 2006 Jan 17; [Epub ahead of print]

Rituximab treatment for glomerulonephritis in HCV-associated mixed

cryoglobulinaemia: efficacy and safety in the absence of steroids.

Quartuccio L, Soardo G, Romano G, Zaja F, CA, Marchi GD, Fabris M,

Ferraccioli G, Vita SD.

Rheumatology Clinic, DPMSC, University of Udine, Italy.

Objective. Rituximab, an anti-CD20 monoclonal antibody, has been used in

lupus nephritis and membranous idiopathic nephropathy and has proved

effective in non-renal manifestations of type II mixed cryoglobulinaemia

(MC) syndrome. We investigated the possible efficacy and safety of rituximab

in the treatment of cryoglobulinaemic nephritis. Methods. Five patients with

active, biopsy-proven, glomerulonephritis in hepatitis C virus (HCV)-related

type II MC syndrome were treated with four weekly infusions of rituximab

(375 mg/m(2)) in monotherapy, without steroids whenever possible. Rituximab

was the first-line therapy in three cases. Results. A rapid and sustained

renal response was observed in all patients, in one of them without

retreatment up to the last follow-up (month 21+). Renal biopsy was repeated

after 6 months in one patient and histopathological improvement was

documented. Three patients relapsed, at months +5, +7 and +12 of follow-up,

respectively. Two of them were then retreated with rituximab and again

presented a rapid improvement in renal function. Maintenance therapy with

rituximab was performed in two patients: nephritis remission was maintained

in both. Fc-gamma receptor 3a (FcgammaRIIIa) genotype characterization was

consistent with the clinical response observed. Rituximab also proved

effective against other active MC manifestations, when present. No major

side-effects occurred and steroids were not required in the follow-up.

Conclusions. Rituximab may provide effective and safe therapy in type II

MC-related glomerulonephritis, possibly as first-line therapy, avoiding

steroids and hazardous immunosuppressive treatment.

PMID: 16418196

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

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