Rituximab May Speed Remission in Refractory Lupus Nephritis

Jnsdttir T, Zickert A, Sundelin B et al. Long-term follow-up in lupus nephritis patients treated with rituximab--clinical and histopathological response. Rheumatology (2013) 52:847-855

A small clinical trial from Sweden shows that the B-cell-depleting drug rituximab (Rituxan) produces a partial or complete renal response in a majority of patients with lupus nephritis (LN) previously resistant to conventional therapy. The non-blinded, observational trial, conducted at the Karolinska Institute, involved 25 patients with active systemic lupus erythematosus (SLE) and biopsy-proven LN, treated with glucocorticoids (GCs).
 
Twenty one patients received four weekly infusions of rituximab (RTX)  with IV cyclophosphamide at the first and fourth RTX infusions. Two patients received RTX with mycophenolate mofetil and two had RTX monotherapy. GCs were temporarily increased during treatment weeks, but rapidly tapered thereafter

After a median of 36 months; 16 patients had a complete response and six had a partial response.  Four of the responders experienced flares.

Four patients had severe adverse events, including severe neutropenia, necrotizing fasciitis, and septicemia. Six had less serious adverse events such as urinary tract or Salmonella infections, and reactivation of H. zoster.