Biopsy-verified response of severe lupus nephritis to treatment with rituximab (anti-CD20 monoclonal antibody) plus cyclophosphamide after biopsy-documented failure to respond to cyclophosphamide alone.

Abstract

BACKGROUND:

The monoclonal anti-B cell antibody rituximab (Rituxin, Mabthera) may be of benefit in antibody-driven diseases, including systemic lupus erythematosus (SLE) nephritis.

PATIENTS AND TREATMENT:

Two female patients with biopsy-confirmed severe and active SLE nephritis despite treatment with cyclophosphamide (CyX) were given four rituximab infusions plus two additional CyX infusions.

RESULTS:

Both patients tolerated the treatment well and SLE activity improved. On repeat kidney biopsy after the combined treatment, Patient 1 showed a profound reduction of nephritis activity, and she was maintained on low-dose prednisolone only. A repeat biopsy after 1 year confirmed the sustained reduction of lupus nephritis activity. In Patient 2, rebiopsy after combined treatment also showed a significant reduction in disease activity.

CONCLUSION:

These cases provide histopathological documentation of a significant treatment benefit from rituximab plus CyX in two patients refractory to CyX alone. This combination is being explored further as salvage therapy for such CyX-resistant patients.

• Authors: R F van Vollenhoven, I Gunnarsson, E Welin-Henriksson, B Sundelin, A Osterborg, S H Jacobson, L Klareskog
• Journal: Scandinavian journal of rheumatology (Scand J Rheumatol) Vol. 33 Issue 6 Pg. 423-7 ( 2004) ISSN: 0300-9742 [Print] England
• PMID: 15794203 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Agents
• Rituximab
• Cyclophosphamide

Topics

• Adult
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Agents (therapeutic use)
• Biopsy, Needle
• Cyclophosphamide (therapeutic use)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Drug Therapy, Combination
• Follow-Up Studies
• Humans
• Immunohistochemistry
• Kidney Function Tests
• Lupus Nephritis (drug therapy, pathology)
• Risk Assessment
• Rituximab
• Severity of Illness Index
• Sweden
• Treatment Outcome