Rituximab treatment for glomerulonephritis in HCV-associated mixed cryoglobulinaemia: efficacy and safety in the absence of steroids.

Abstract

OBJECTIVE:

Rituximab, an anti-CD20 monoclonal antibody, has been used in lupus nephritis and membranous idiopathic nephropathy and has proved effective in non-renal manifestations of type II mixed cryoglobulinaemia (MC) syndrome. We investigated the possible efficacy and safety of rituximab in the treatment of cryoglobulinaemic nephritis.

METHODS:

Five patients with active, biopsy-proven, glomerulonephritis in hepatitis C virus (HCV)-related type II MC syndrome were treated with four weekly infusions of rituximab (375 mg/m2) in monotherapy, without steroids whenever possible. Rituximab was the first-line therapy in three cases.

RESULTS:

A rapid and sustained renal response was observed in all patients, in one of them without retreatment up to the last follow-up (month 21+). Renal biopsy was repeated after 6 months in one patient and histopathological improvement was documented. Three patients relapsed, at months +5, +7 and +12 of follow-up, respectively. Two of them were then retreated with rituximab and again presented a rapid improvement in renal function. Maintenance therapy with rituximab was performed in two patients: nephritis remission was maintained in both. Fc-gamma receptor 3a (FcgammaRIIIa) genotype characterization was consistent with the clinical response observed. Rituximab also proved effective against other active MC manifestations, when present. No major side-effects occurred and steroids were not required in the follow-up.

CONCLUSIONS:

Rituximab may provide effective and safe therapy in type II MC-related glomerulonephritis, possibly as first-line therapy, avoiding steroids and hazardous immunosuppressive treatment.

• Authors: L Quartuccio, G Soardo, G Romano, F Zaja, C A Scott, G De Marchi, M Fabris, G Ferraccioli, S De Vita
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 45 Issue 7 Pg. 842-6 (Jul 2006) ISSN: 1462-0324 [Print] England
• PMID: 16418196 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Antiviral Agents
• FCGR3A protein, human
• Glucocorticoids
• Receptors, IgG
• Rituximab

Topics

• Aged
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Murine-Derived
• Antiviral Agents (adverse effects, therapeutic use)
• Cryoglobulinemia (complications)
• Drug Administration Schedule
• Drug Evaluation
• Female
• Glomerulonephritis (drug therapy, genetics, pathology)
• Glucocorticoids (administration & dosage)
• Hepatitis C (complications)
• Humans
• Male
• Middle Aged
• Polymorphism, Genetic
• Receptors, IgG (genetics)
• Recurrence
• Rituximab
• Treatment Outcome