USE OF RITUXIMAB IN PATIENTS WITH LUPUS NEPHRITIS
https://doi.org/10.14412/1995-4484-2010-1161
Abstract
Objective: To evaluate the impact of rituximab (RTM) therapy on the clinical, morphological, and immunological parameters of lupus
nephritis (LN) activity.
Subjects and methods. The study included 19 patients with types III and IV LN (WHO classification) with its 6-133-month history. Their
mean age was 28,6 years (18-63 years). RTM was given in a dose of 500 mg weekly for 4 weeks or 1000 mg twice at an interval of 2
weeks. Fourteen patients received a complete course of RTM therapy. Five cases could not complete the course due to poor tolerability or
death. Renal rebiopsy was performed in 8 patients 6-12 months after therapy initiation.
Results. Thirteen patients achieved partial remission in different follow-up periods. Complete remission was noted in 7 patients a year after a
course of RTM therapy. There were no exacerbations of LN in remission patients. Just a month after therapy was marked by a decline in the
systemic lupus erythematosus disease activity index (SLEDAI 2K) from 20.4+7.3 to 14.3+6.5 (p<0.05). A significant anti-dsDNA antibody
titer decrease and C3 and C4 normalization were detectable at 3-6-12 months. Overall, RTM therapy proved to be effective in 13 (68%) of
the 19 patients. Morphological re-examination of renal biopsy specimens revealed that all cases had a considerable average reduction in morphological
activity index from 8 (6-9) to 3 (1-4) (p=0.027). Transformation of LN to its better type was found in 5 cases. RTM therapy
turned out to be ineffective in 6 patients with evident renal failure. There were no serious adverse reactions and complications after RTM use.
Conclusion. RPM therapy results in a reduction in the clinical, laboratory, and morphological activity of LN in most cases provided that
renal nitrogen-excretory function is preserved at therapy start.
nephritis (LN) activity.
Subjects and methods. The study included 19 patients with types III and IV LN (WHO classification) with its 6-133-month history. Their
mean age was 28,6 years (18-63 years). RTM was given in a dose of 500 mg weekly for 4 weeks or 1000 mg twice at an interval of 2
weeks. Fourteen patients received a complete course of RTM therapy. Five cases could not complete the course due to poor tolerability or
death. Renal rebiopsy was performed in 8 patients 6-12 months after therapy initiation.
Results. Thirteen patients achieved partial remission in different follow-up periods. Complete remission was noted in 7 patients a year after a
course of RTM therapy. There were no exacerbations of LN in remission patients. Just a month after therapy was marked by a decline in the
systemic lupus erythematosus disease activity index (SLEDAI 2K) from 20.4+7.3 to 14.3+6.5 (p<0.05). A significant anti-dsDNA antibody
titer decrease and C3 and C4 normalization were detectable at 3-6-12 months. Overall, RTM therapy proved to be effective in 13 (68%) of
the 19 patients. Morphological re-examination of renal biopsy specimens revealed that all cases had a considerable average reduction in morphological
activity index from 8 (6-9) to 3 (1-4) (p=0.027). Transformation of LN to its better type was found in 5 cases. RTM therapy
turned out to be ineffective in 6 patients with evident renal failure. There were no serious adverse reactions and complications after RTM use.
Conclusion. RPM therapy results in a reduction in the clinical, laboratory, and morphological activity of LN in most cases provided that
renal nitrogen-excretory function is preserved at therapy start.
About the Authors
Anna Vasilyevna TorgashinaS K Solovyev
E N Aleksandrova
S G Radenska-Lopovok
E L Nasonov
References
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For citations:
Torgashina A.V., Solovyev S.K., Aleksandrova E.N., Radenska-Lopovok S.G., Nasonov E.L. USE OF RITUXIMAB IN PATIENTS WITH LUPUS NEPHRITIS. Rheumatology Science and Practice. 2010;48(4):14-26. (In Russ.) https://doi.org/10.14412/1995-4484-2010-1161
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