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BMC Nephrol. 2018 Sep 20;19(1):241. doi: 10.1186/s12882-018-1038-7.

Use of rituximab as an induction therapy in anti-glomerular basement-membrane disease.

Author information

1
Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, CHU Grenoble-Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France.
2
Université Grenoble-Alpes, Grenoble, France.
3
Laboratoire d'Immunologie, CHU Grenoble-Alpes, La Tronche, France.
4
Laboratoire d'Anatomie Pathologique, CHU Grenoble-Alpes, La Tronche, France.
5
Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, CHU Grenoble-Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France. lrostaing@chu-grenoble.fr.
6
Université Grenoble-Alpes, Grenoble, France. lrostaing@chu-grenoble.fr.

Abstract

BACKGROUND:

Anti-glomerular basement-membrane (anti-GBM) disease (or Goodpasture disease) is characterized by severe kidney and lung involvement. Prognoses have improved with treatments that combine plasma exchange and immunosuppressive drugs. However, patients with severe renal involvement can have poor renal outcomes and cyclophosphamide can cause significant complications. Anti-GBM antibodies have a direct pathogenic effect on the disease: thus, therapeutics that can decrease their production, such as rituximab, could be a good alternative.

METHODS:

The medical files of five patients that had received rituximab as a first-line therapy (instead of cyclophosphamide), plus plasma exchange and steroids, were reviewed. All patients had severe disease manifestations.

RESULTS:

Four patients required dialysis at diagnosis and remained dialysis-dependent over the mean follow-up of 15 months. Three patients had pulmonary involvement, but recovered even though mechanical ventilation was required. Anti-GBM antibodies became rapidly undetectable in all patients. One infectious and two hematological complications were observed.

CONCLUSIONS:

We report the outcomes of five patients with Goodpasture disease and treated with rituximab as a first-line treatment. This strategy was effective at treating pulmonary manifestations and was associated with a good biological response with no major serious adverse events. However, renal outcomes were not significantly improved.

KEYWORDS:

Anti-glomerular basement-membrane disease; Goodpasture disease; Induction therapy; Rituximab

PMID:
30236081
PMCID:
PMC6149204
DOI:
10.1186/s12882-018-1038-7
[Indexed for MEDLINE]
Free PMC Article

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