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

Abstract

OBJECTIVE:

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.

• Authors: Thórunn Jónsdóttir, Iva Gunnarsson, Ana Filipa Mourão, Tim Y Lu, Ronald F van Vollenhoven, David Isenberg
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 49 Issue 8 Pg. 1502-4 (Aug 2010) ISSN: 1462-0332 [Electronic] England
• PMID: 20427294 (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