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Clinical improvements in proliferative vs membranous lupus nephritis following B-cell depletion: pooled data from two cohorts.

AbstractOBJECTIVE:
To compare the clinical results after treatment with B-cell depleting therapy in patients with membranous (WHO Class V) vs proliferative (WHO Class III or IV) lupus nephritis (LN).
METHODS:
Data were compiled from two European centres on all patients with LN who were treated with i.v. rituximab (RTX) in a combination protocol with i.v. cyclophosphamide and steroids. Laboratory and serological evaluations were performed at 3, 6 and 12 months of follow-up. No immunosuppressive drugs were given before B-cell repopulation.
RESULTS:
Forty-three patients, 28 with proliferate and 15 with membranous LN by renal biopsy, were evaluated. Six months after treatment with RTX, both the membranous and the proliferative LN patients had a significant reduction in proteinuria and an increase in serum albumin. The main improvements were observed during the first 6 months and only minor non-significant changes in albumin and proteinuria were observed thereafter. As expected, the patients with membranous nephritis had lower anti-dsDNA titres and higher complement C3 levels at baseline, but in both groups a significant reduction in anti-dsDNA titre and improvements in complement C3 levels were seen during the first 6 months after treatment; the kinetics of improvement were similar in both groups.
CONCLUSION:
The clinical course following B-cell depleting therapy is strikingly similar between patients with membranous and those with proliferative LN. These observational data suggest that, if controlled studies confirm the efficacy of B-cell depleting therapy in proliferative nephritis, clinicians may reasonably consider such therapy in membranous LN.
AuthorsThórunn Jónsdóttir, Iva Gunnarsson, Ana Filipa Mourão, Tim Y Lu, Ronald F van Vollenhoven, David Isenberg
JournalRheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 49 Issue 8 Pg. 1502-4 (Aug 2010) ISSN: 1462-0332 [Electronic] England
PMID20427294 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antibodies, Monoclonal, Murine-Derived
  • Immunosuppressive Agents
  • Serum Albumin
  • Steroids
  • Rituximab
  • Cyclophosphamide
Topics
  • Adolescent
  • Adult
  • Antibodies, Monoclonal, Murine-Derived (therapeutic use)
  • B-Lymphocytes (metabolism)
  • Clinical Trials as Topic
  • Cohort Studies
  • Cyclophosphamide (therapeutic use)
  • Disease Progression
  • Drug Therapy, Combination
  • Europe
  • Follow-Up Studies
  • Humans
  • Immunosuppressive Agents (therapeutic use)
  • Lupus Nephritis (classification, drug therapy)
  • Middle Aged
  • Proteinuria (blood)
  • Rituximab
  • Serum Albumin (analysis)
  • Severity of Illness Index
  • Steroids (therapeutic use)
  • Time Factors
  • Treatment Outcome
  • Young Adult

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