TY - JOUR
TI - Rituximab and mycophenolate mofetil for relapsing proliferative lupus
nephritis: a long-term prospective study
AU - Boletis, John N.
AU - Marinaki, Smaragde
AU - Skalioti, Chryssanthe and
AU - Lionaki, Sofia S.
AU - Iniotaki, Aliki
AU - Sfikakis, Petros P.
JO - Nephrology Dialysis Transplantation
PY - 2009
VL - 24
TODO - 7
SP - 2157-2160
PB - Oxford University Press
SN - 0931-0509, 1460-2385
TODO - 10.1093/ndt/gfp002
TODO - CD20; mycophenolate mofetil; nephritis; relapse; rituximab; systemic
lupus erythematosus
TODO - Methods. This prospective, observational study included 10 women with
biopsy-proven relapse of proliferative lupus nephritis occurring during
maintenance with mycophenolate mofetil (MMF) or azathioprine. The
long-term outcome after a single course of the B-cell depleting
anti-CD20 antibody rituximab (4 weekly infusions of 375 mg/m(2)),
combined with daily MMF (2 g) and prednisolone (0.5 mg/ kg/day for 4
weeks, tapered thereafter) is presented.
Results. While renal function was not severely impaired at baseline,
partial remission (> 50% improvement in all abnormal renal parameters)
was achieved in eight patients at a median of 3.5 months. In seven
patients, with 24-h urinary protein of 2.5 +/- 1.1 g (mean +/- SD),
complete remission, associated with increases in serum complement levels
and decreases in anti-dsDNA titres, was subsequently established (normal
serum creatinine/albumin levels, inactive urine sediment and 24-h
urinary protein < 0.5 g). Complete nephritis remission was sustained at
the follow-up end (median of 38 months) in six patients. Combination
treatment was well tolerated.
Conclusions. The efficacy of this low-toxicity combination was
particularly evident in patients with subnephrotic proteinuria due to
proliferative lupus nephritis relapse. Controlled trials to define the
role of rituximab/MMF in this condition are warranted.
ER -