BACKGROUND: Idiopathic membranous nephropathy (MN) is a major cause of nephrotic syndrome. Conventional treatment strategies induce remission but the relapse rates are high. Different doses of rituximab (RTX) appeared effective in reducing proteinuria in MN but long-term follow-up data are rare. METHODS: Since 2006, a total of 14 patients (median age 51 (26 - 69) years, 4 women, 10 men) with biopsy-proven MN (1 - 4 relapses, MN since 4 (1 - 13) years) were treated with RTX (4 doses of RTX 375 mg/m2 on Days 0, 30, 60, 90). All patients had prior immunosuppressive therapy with Cyclosporin A, 7 with alkylating agents. In 11 patients, an additional renal biopsy was performed 2 (1 - 10) months before RTX. RESULTS: Three months after the last RTX infusion, proteinuria decreased from a baseline of 5.5 (2.9 - 11.9) g/24 h to 1.8 (0.03 - 8.7) g/24 h (p = 0.012). Creatinine clearance remained stable (53 (29 - 160) ml/min at 3 months vs. 44 (29 - 159) at baseline). Until now, patients could be followed for a median of 3 (1 - 6) years. After 1 year, 21.4% (n = 3) had a complete response, 50.0% (n = 7) partial response. Two relapses occurred after 1 and 3.5 years. The presence of glomerulosclerosis before RTX was associated with a poorer outcome. CONCLUSIONS: The 4 × 4-weekly infusion of RTX is a reasonable option for the second- and third line therapy of MN providing a better safety profile compared to other immunosuppressive treatments of MN.
BACKGROUND:Idiopathic membranous nephropathy (MN) is a major cause of nephrotic syndrome. Conventional treatment strategies induce remission but the relapse rates are high. Different doses of rituximab (RTX) appeared effective in reducing proteinuria in MN but long-term follow-up data are rare. METHODS: Since 2006, a total of 14 patients (median age 51 (26 - 69) years, 4 women, 10 men) with biopsy-proven MN (1 - 4 relapses, MN since 4 (1 - 13) years) were treated with RTX (4 doses of RTX 375 mg/m2 on Days 0, 30, 60, 90). All patients had prior immunosuppressive therapy with Cyclosporin A, 7 with alkylating agents. In 11 patients, an additional renal biopsy was performed 2 (1 - 10) months before RTX. RESULTS: Three months after the last RTX infusion, proteinuria decreased from a baseline of 5.5 (2.9 - 11.9) g/24 h to 1.8 (0.03 - 8.7) g/24 h (p = 0.012). Creatinine clearance remained stable (53 (29 - 160) ml/min at 3 months vs. 44 (29 - 159) at baseline). Until now, patients could be followed for a median of 3 (1 - 6) years. After 1 year, 21.4% (n = 3) had a complete response, 50.0% (n = 7) partial response. Two relapses occurred after 1 and 3.5 years. The presence of glomerulosclerosis before RTX was associated with a poorer outcome. CONCLUSIONS: The 4 × 4-weekly infusion of RTX is a reasonable option for the second- and third line therapy of MN providing a better safety profile compared to other immunosuppressive treatments of MN.
Authors: Andrea Angioi; Nicola Lepori; Ana Coloma López; Sanjeev Sethi; Fernando C Fervenza; Antonello Pani Journal: J Nephrol Date: 2017-09-05 Impact factor: 3.902
Authors: Philipp Gauckler; Jae Il Shin; Federico Alberici; Vincent Audard; Annette Bruchfeld; Martin Busch; Chee Kay Cheung; Matija Crnogorac; Elisa Delbarba; Kathrin Eller; Stanislas Faguer; Kresimir Galesic; Siân Griffin; Martijn W F van den Hoogen; Zdenka Hrušková; Anushya Jeyabalan; Alexandre Karras; Catherine King; Harbir Singh Kohli; Gert Mayer; Rutger Maas; Masahiro Muto; Sergey Moiseev; Balazs Odler; Ruth J Pepper; Luis F Quintana; Jai Radhakrishnan; Raja Ramachandran; Alan D Salama; Ulf Schönermarck; Mårten Segelmark; Lee Smith; Vladimír Tesař; Jack Wetzels; Lisa Willcocks; Martin Windpessl; Ladan Zand; Reza Zonozi; Andreas Kronbichler Journal: Kidney Int Rep Date: 2021-01-13