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

Thórunn Jónsdóttir*, Iva Gunnarsson, Ana Filipa Mourão, Tim Y. Lu, Ronald F. van Vollenhoven, David Isenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Citations (Scopus)

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 t-dsDNA itre 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.

Original languageEnglish
Article numberkeq055
Pages (from-to)1502-1504
Number of pages3
JournalRheumatology
Volume49
Issue number8
DOIs
Publication statusPublished - 27 Apr 2010

Bibliographical note

Funding Information:
Funding: Supported by a grant from King Gustaf V’s 80th Birthday Fund and by funds from the Karolinska Institutet.

Other keywords

  • Anti-CD20
  • Lupus nephritis
  • Rituximab
  • Systemic lupus erythematosus
  • Treatment

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