Efficacy and tolerability of rituximab with or without PEGylated interferon alfa‐2b plus ribavirin in severe hepatitis C virus–related vasculitis: A long‐term followup study of thirty‐two patients

Terrier, Benjamin; Saadoun, David; Sène, Damien; Sellam, Jérémie; Pérard, L.; Coppéré, B.; Karras, Alexandre; Blanc, F; Büchler, Matthias; Plaisier, Emmanuelle; Ghillani, Pascale; Rosenzwajg, Michèlle; Cacoub, Patrice

doi:10.1002/art.24703

Cited by 99 publications

(61 citation statements)

References 37 publications

(15 reference statements)

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“…On the other hand, rituximab has a very favorable benefitto-tolerance ratio in this subgroup of patients. This treatment has been proposed in several kidney diseases such as mixed hepatitis-C-related cryoglobulinemic MPGN (18) or idiopathic MN (19). In the series reported by Nasr (8), two of four patients with MPGN and monoclonal IgG deposits who received this B cell-depleting drug experienced PR.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Noncryoglobulinemic Glomerulonephritis with Monoclonal Ig Deposits

Guiard

Karras²,

Plaisier³

et al. 2011

Clinical Journal of the American Society of Nephrology

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118

110

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SummaryBackground and objectives Several different entities have recently been described among glomerular diseases associated with monoclonal IgG deposits. The aim of this study was to describe the distribution of the different pathologic subtypes of IgG-associated glomerulopathy and to evaluate the IgG isotype involved in these diseases.Design, setting, participants, & measurements This was a retrospective study including all patients with glomerular deposits of monoclonal IgG referred to three nephrology departments between 1980 and 2008.Results Twenty-six patients were included. Nephrotic syndrome was almost constantly associated with a renal dysfunction in 14 of 26 patients. The presence of M-spike was detected in only 30% of the patients, and an overt hematologic malignancy (myeloma, lymphoma) was identified in 9 of 26 patients. Patients were almost equally divided into two distinct histologic patterns: membranous nephropathy (MN) or membranoproliferative glomerulonephritis (MPGN). IgG3 deposits were identified in 80% of patients with MPGN, whereas IgG1 deposits were present in 64% of patients with MN. Ultrastructural study showed that immune deposits were nonorganized in most patients. Seven patients were treated with rituximab with excellent results: five of seven had a complete remission of the nephrotic syndrome and two of seven had a partial response. After a mean 24-month follow-up, only one patient experienced relapse of the nephropathy.Conclusions GN with monoclonal Ig deposits can be associated with MPGN or MN, which are correlated with IgG3 and IgG1 isotypes, respectively. Rituximab appears to have a very favorable benefit-to-risk ratio for patients with no overt hematologic malignancy.

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Section: Discussionmentioning

confidence: 99%

Patterns of Noncryoglobulinemic Glomerulonephritis with Monoclonal Ig Deposits

Guiard

Karras²,

Plaisier³

et al. 2011

Clinical Journal of the American Society of Nephrology

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118

110

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“…Encouraging results have been obtained in open-label studies and single case reports. RTX improves or cures various clinical manifestations of MC, including fatigue, purpura and skin ulcers, arthralgias and arthritis, glomerulonephritis (in about 90% of cases), peripheral neuropathy (in about 75% of cases), and hyperviscosity syndrome [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50] and [51]. RTX was also reported to be effective in some life-threatening cases of gastrointestinal vasculitis [43].…”

Section: Mixed Cryoglobulinemia-associated Glomerulonephritismentioning

confidence: 99%

“…Except for transplanted patients, no life-threatening infections have been reported in typical HCV-related MC after RTX administration. While antiviral drugs administered with RTX may possibly be synergic [44], [56], [57], [58] and [59], they multiply the adverse effects thereby making treatment poorly tolerated. Until recently, it was believed that staggered administration after a critical phase of vasculitis was mandatory in order to avoid the risk of exacerbating HCV infection, but in most cases it is probably unnecessary [60].…”

Section: Mixed Cryoglobulinemia-associated Glomerulonephritismentioning

confidence: 99%

Rituximab-based novel strategies for the treatment of immune-mediated glomerular diseases

Kattah¹,

Fervenza²,

Roccatello³

2013

Autoimmunity Reviews

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Rituximab is a monoclonal antibody to the CD20 antigen on B-cells that was initially designed and approved for the treatment of non-Hodgkin's B-cell lymphoma in 1997.In the last 15 years, it has emerged as a potent immunosuppressant for many immune-mediated diseases, beginning initially with rheumatoid arthritis, and now extending into several other fields, including clinical nephrology. Based on recent large clinical trials, it is FDA-approved for the treatment of ANCA-associated vasculitis and continues to be studied in off-label usage for many glomerular diseases, including membranous nephropathy, lupus nephritis, and mixed cryoglobulinemia. It has been used as a treatment in nephrotic syndrome in children and adults, including both minimal change disease and focal segmental glomerulosclerosis. Given its efficacy, tolerability and safety profile in comparison to more conventional treatment regimens, RTX is rapidly emerging as a critical treatment modality in glomerular disease.

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“…Thus, to avoid this adverse effect and stabilize the deletion of expanded B-cell clones, it seemed reasonable to combine Peg-IFN-␣ and RBV with RTX (termed PIRR). 16,32 We here describe a long-term, single-center experience with this combination in selected adult patients with HCV-related MC and no prior exposure to immunosuppressive or antiviral drugs.…”

Section: Introductionmentioning

confidence: 99%