Rituximab effective, safe for pure membranous lupus nephritis
Rituximab may be an effective treatment option for pure membranous lupus nephritis (MLN) while having a good tolerance profile, a new multicentre retrospective study has shown.
In the study sample of 15 systemic lupus erythematosus (SLE) patients with pure lupus nephritis (mean age 37 years; 87 percent female; median SLE duration 1.5 years), rituximab treatment was started following unresolved proteinuria lasting 3 to 6 months.
Over a median follow-up period of 29 (6 to 112) months, two patients experienced rituximab failure after 12 months of treatment, and two were unresponsive within the first 6 months of treatment.
Remission after a year of treatment was reported in 87 percent (n=13) of the cohort. Of these, 60 percent of patients (n=9) experienced complete remission, while the rest experienced only partial remission, yielding a cumulative property of remission of 73 and 87 percent at months 6 and 12, respectively. The median time to complete remission was 10 months.
Median proteinuria showed substantial changes, improving from 4.9 g protein/g creatinine at baseline to 0.2 g/g at 12 months and to 0.1 g/g at 24 months. Three patients (20 percent) who achieved complete remission experienced proteinuria relapse, resulting in a cumulative risk of relapse of 10 percent at 12 months and of 41 percent at 36 months.
Patients with pure MLN who received rituximab as therapy were identified from 27 medical centres across France. Those who had SLE were eligible. Exclusion criteria included membranous nephropathy and receiving high doses of corticosteroids or immunosuppressive therapy.