RESEARCH - Rituximab an option for relapsing or refractory lupus nephritis

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Rituximab an Option for Relapsing or Refractory Lupus Nephritis

March 10, 2009 — Treatment with the targeted drug rituximab can

significantly benefit some patients with severe lupus nephritis who do

not respond to conventional therapy, according to results of a

retrospective analysis reported in the March issue of the Clinical

Journal of the American Society of Nephrology.

" Standard treatment for lupus nephritis, including corticosteroids and

cyclophosphamide, is efficient but is still associated with refractory

or relapsing disease, or severe deleterious effects, " write

Melander, MD, from the department of nephrology, Assistance

Publique–Hôpitaux Paris, France, and colleagues. " Rituximab, a

monoclonal chimeric anti-B cell antibody, is increasingly used in

patients with lupus nephritis, but reported series were small and had

a short follow-up. "

The goal of this study was to assess long-term (>12 months) efficacy

and safety of rituximab in 20 systemic lupus erythematosus patients

with severe proliferative or membranous lupus nephritis.

The patients (19 women and 1 man) were identified from chart reviews

from 8 French nephrology centers between October 2003 and December

2006. The patients had to have at least 12 months of follow-up data

and have active class III, IV, or V lupus nephritis established by

kidney biopsy less than 3 months before rituximab initiation. Kidney

biopsy disclosed class IV lupus nephritis in 15 patients and class V

lupus nephritis in 5 patients.

Rituximab was administered weekly for 4 weeks at a dose of 375 mg/m2

of body surface area, with the exception of 2 patients who received 3

injections. Twelve patients received rituximab for lupus nephritis

refractory to standard treatment, 6 patients were treated for

relapsing disease, and 2 patients received rituximab as first-line

therapy. Three patients received cyclophosphamide concomitantly with

rituximab. Ten patients received new injections of rituximab as

maintenance therapy.

After a median follow-up of 22 months (range, 10 – 51 months),

complete renal remission was obtained in 7 patients, and partial renal

remission was obtained in 5 patients, for an overall renal response

rate of 60%.

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Read the full article here:

http://www.medscape.com/viewarticle/589348

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