Treatment with rituximab in idiopathic membranous nephropathy

Abstract

BackgroundRituximab represents a valid therapeutic option to induce remission in patients with primary glomerulonephritis. Despite several studies proving its efficacy in improving outcomes in patients with membranous nephropathy (MN), its role in therapeutic protocols is not yet defined.MethodsWe studied 38 patients with idiopathic MN treated with rituximab (in 13 patients as first-line therapy, in the remaining 25 after conventional immunosuppressive therapy). The patients were analyzed for a 15-month median (interquartile range 7.7–30.2) follow-up, with serial monitoring of 24-h proteinuria, renal function and circulating CD19+ B cells.ResultsThe percentages of patients who achieved complete remission, partial remission and the composite endpoint (complete or partial remission) were 39.5% (15 patients), 36.8% (14 patients) and 76.3% (29 patients), respectively. The 24-h proteinuria was reduced significantly during the entire period of follow-up (from a baseline value of 6.1 to 0.9 g/day in the last visit; P < 0.01), while albuminemia increased constantly (from a baseline value of 2.6 to 3.5 g/dL in the last observation; P < 0.01). Renal function did not significantly change during the observation period. Circulating CD19+ B cells were reduced significantly from the baseline value to the 24-month value (P < 0.01); data about anti-phospholipase A2 receptor antibodies were available in 14 patients, 10 of which experienced a decreasing trend after treatment. No significant adverse events were described during and after infusions.ConclusionsThe present study confirmed that treatment with rituximab was remarkably safe and allowed for a large percentage of complete or partial remissions in patients with MN.

Low-dose Rituximab therapy in resistant idiopathic membranous nephropathy: single-center experience

“…The time to remission after last dose of RTX was 2.7 months (1.2–7 months) in our study. This response time is shorter than that reported from other studies, where patients have responded even after 12 months [ 18 , 19 , 23 ]. Whether more patients will ultimately achieve remission with longer follow-up in our cohort needs to be seen.…”

Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts

“…Despite the small proportion of studies, the absence of serious adverse events and a little significant side effects is suggestive of the safety of RTX therapy, contrary to what is reported in the several studies, where nonserious (chills, skin rash, fever) and serious adverse events (angioedema, Steven-Johnson syndrome, bronchospasm) have been described (30,31). Longer follow-ups and larger patients are necessitated to definitely establish whether treatment with rituximab does not increase the risk of opportunistic infections or malignancies when used as immunosuppression in second-line (30). Data from a remarkably large series of rituximab therapy in primary glomerular diseases (32) nephropathy (33), lymphoproliferative disorders (34) and autoimmune diseases (35) show that rituximab is safe.…”

Rituximab in kidney disease and transplant

“…Renal function did not significantly change during the observation period. Circulating CD19 + B‐cells were reduced significantly from the baseline value to the 24‐month value ( P < 0.01) . Clinical outcomes of IMN patients treated with rituximab are summarized in Table .…”