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Rheumatology (Oxford). 2010 Aug;49(8):1502-4. doi: 10.1093/rheumatology/keq055. Epub 2010 Apr 27.

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

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  • 1Department of Medicine, Unit of Rheumatology, Karolinska University Hospital, Karolinska Institutet, S-171 76 Stockholm, Sweden. thorunn.jonsdottir@karolinska.se

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.

PMID:
20427294
[PubMed - indexed for MEDLINE]
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