Background Lupus nephritis(LN) can be a cause of morbidity and mortality. The treatment of lupus nephritis can be challenging in some patients who are resistant to conventional immunosuppressive treatment. There are case series showing the efficacy of rituximab on systemic lupus erythematosus (SLE) patients, but there are no randomized clinical trials. Therefore, we evaluated the efficacy and safety of rituximab treatment in LN patients in our clinic retrospectively.
Methods We evaluated LN patients who were followed and treated with at least one course of rituximab in our clinic between 2013–2018, retrospectively. We evaluated all of the patients before rituximab treatment and 3 months after the final rituximab course with 24 hour proteinuria. Remission was defined as proteinuria below 500 mg/day. Also, we evaluated the reason behind the cessation of rituximab during the follow-up whether it is a side effect or lack of efficacy.
Results Thirty-two patients (19 F, 13 M) were treated with rituximab. All of the patients had active lupus nephritis at initiation. Median of disease duration was 4 years. Diagnosis was proven by renal biopsy, except two patients, which is shown in table 1 of histological characteristics. Patients received an average of 4.2±3.8 courses. All patients were treated with high dose steroids. The other medications, the patients were previously treated with, were Cyclophosphamide (n=25), Azathioprine (n=7), Mycophenolate mofetil (n=17). Also one patient was treated with plasmapheresis due to thrombotic thrombocytopenic purpura. Two patients were lost in follow-up. Twelve patients (38%) are still on rituximab, in which 5 of them (42%) still have active LN. Treatment of 11 out of 18 patients was terminated owing to remission of disease. All of the patients whom rituximab was terminated in disease remission did not flare, except one. Moreover, in 7 patients, treatment was terminated because 3 had inadequate response, 2 had severe infection (cellulitis, pneumonia), 1 had Rituximab-induced serum sickness, 1 had will of pregnancy. The mean level of proteinuria decreased from 3440±2476 mg/day to 927±895 mg/day(p<0,0001). Additionally, there was a reduce in steroid dose from 23,75±19,6 mg/day to 9,02±10,59 mg/day (p<0,0001). None of the patients had a new organ involvement during therapy.
Conclusions In our single center, most of the patients were class IV nephritis whom we observed the efficacy of rituximab. Generally, the side effects were acceptable. Rituximab can be a steroid sparing agent in these patients.
Funding Source(s): None
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