Rituximab in nephrologist’s hands – first experience
Authors:
Z. Hrušková 1,2; H. Marečková 2; E. Jančová 1; R. Ryšavá 1; V. Tesař 1
Authors‘ workplace:
Klinika nefrologie VFN a 1. LF UK v Praze, 2Ústav imunologie a mikrobiologie VFN a 1. LF UK v Praze
1
Published in:
Čes. Revmatol., 17, 2009, No. 3, p. 127-133.
Category:
Original Papers
Overview
In nephrologic patients refractory to standard combined immunosuppressive therapy, or in those not tolerating it, biological therapy, including rituximab, has recently become a possible alternative. Rituximab (RTX) is a chimeric monoclonal antibody against the antigen CD20. Administration of RTX causes a selective transient depletion of B lymphocytes. In this article, our present experience with the use of RTX is summarized and commented. In our department, RTX has been so far administered to 17 patients with various nephrologic diagnoses (7x ANCA associated vasculitis - AAV, 5x systemic lupus erythematosus - SLE, 2x cryoglobulinaemia associated with hepatitis C virus infection - KG, 2x membranous nephropathy - MGN, 1x thrombotic thrombocytopenic purpura – TTP). In 7 patients, 4x375 g/m2 of rituximab was administered weekly. In 10 patients, the dose used was 1 g each separated by 2 weeks. Out of 15 patients with a follow-up longer than 1 year, at least partial remission has been achieved in all treated patients with SLE, KG and TTP, and also in some patients with AAV. In AAV patients with predominant granulomatous involvement, and in patients with MGN, the treatment with RTX was not successful. RTX was well tolerated in most patients; mild adverse events (fever, chills) were observed in 3 out of 17 patients (18%). Thus, rituximab seems to be a safe and effective drug in the therapy of some nephrologic diseases, even though the results of larger trials, which would unambiguously answer the questions of proper indications, the best administration strategy, possibility of repeated treatment and long-term safety, are still missing.
Key words:
biological therapy, glomerulonephritis, monoclonal antibody, refractory disease, rituximab
Sources
1. Zbořil V. Biologická terapie v gastroenterologii. Čes a Slov Gastroent a Hepatol 2007; 61(6): 287–292.
2. Salama AD, Pusey CD. Drug Insight: rituximab in renal disease and transplantation. Nat Clin Pract Nephrol 2006; 2: 221–30.
3. Thatayatikom A, White AJ. Rituximab: A promising therapy in systemic lupus erythematosus. Autoimmun Rev 2006; 5:18–24.
4. Flossmann O, Jones RB, Jayne DRW, Luqmani RA. Should rituximab be used to treat antineutrophil cytoplasmic antibody associated vasculitis? Ann Rheum Dis 2006; 65: 841–4.
5. Anolik JH, Campbell D, Felgar RE, Young F, Sanz I, Rosenblatt J, et al. The relationship of FcgammaRIIIa genotype to degree of B cell depletion by rituximab in the treatment of systemic lupus erythematosus. Arthritis Rheum 2003; 48: 455–9.
6. Sfikakis PP, Boletis JN, Lionaki S, Vigklis V, Fragiadaki KG, Iniotaki A, et al. Remission of proliferative lupus nephritis following B cell depletion therapy is preceded by down/regulation of the T cell costimulatory molecule CD40 Ligand. Arthritis Rheum 2005; 52: 501–513.
7. Gottenberg JE, Guillevin L, Lambotte O, Combe B, Allanore Y, Cantagrel A, et al. Club Rheumatismes et Inflammation (CRI). Tolerance and short term efficacy of rituximab in 43 patients with systemic autoimmune diseases. Ann Rheum Dis 2005; 64: 913–20.
8. Looney RJ, Anolik JH, Campbell D, Felgar RE, Young F, Arend LJ, et al. B cell depletion as a novel treatment for systemic lupus erythematosus: a phase I/II dose-escalation trial of rituximab. Arthritis Rheum 2004; 50:2580–9.
9. Leandro MJ, Cambridge G, Edwards JC, Ehrenstein MR, Isenberg DA. B-cell depletion in the treatment of patients with systemic lupus erythematosus: a longitudinal analysis of 24 patients. Rheumatology 2005; 44:1542–5.
10. Keogh KA, Ytterberg SR, Fervenza FC, Carlson KA, Schroeder DR, Specks U. Rituximab for refractory Wegener’s granulomatosis: report of a prospective, open-label pilot trial. Am J Respir Crit Care Med. 2006; 173:180–7.
11. Roccatello D, Baldovino S, Rossi D, Mansouri M, Naretto C, Gennaro M, et al. Long-term effects of anti-CD20 monoclonal antibody treatment of cryoglobulinaemic glomerulonephritis. Nephrol Dial Transplant 2004; 19: 3054–61.
12. Jones R, Savage C, Peh CA. Rituximab: A novel remission induction agent in ANCA associated vasculitis. The design of an international, randomised trial (RITUXVAS). J Am Soc Nephrol 2007;18: 972A.
13. Edwards JC, Szczepanski L, Szechinski J, Filipowicz-Sosnowska A, Emery P, Close DR, et al. Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis. N Engl J Med 2004; 350: 2572–81.
14. Morgan MD, Harper L, Williams J, Savage C. Anti-neutrophil cytoplasm-associated glomerulonephritis. J Am Soc Nephrol 2006; 17: 1224–1234.
15. Stasi R, Stipa E, Del Poeta G, Amadori S, Newland AC, Provan D. Long-term observation of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis treated with rituximab. Rheumatology 2006; 45: 1432–36
16. Aries PM, Hellmich B, Voswinkel J, Both M, Nölle B, Holl-Ulrich K, et al. Lack of efficacy of rituximab in Wegener’s granulomatosis with refractory granulomatous manifestations. Ann Rheum Dis 2006; 65: 853–58.
17. Lu TY, Ng KP, Cambridge G, Leandro MJ, Edwards JC, Ehrenstein M, et al. A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at university college london hospital: The first fifty patients. Arthritis Rheum 2009; 61: 482–7.
18. A Study to Evaluate the Efficacy and Safety of Rituximab in Patients With Severe Systemic Lupus Erythematosus (EXPLORER) (online). Citováno 13.05.2009. Dostupné z: http://clinicaltrials.gov/ct2/show/NCT00137969.
19. Cohen CD, Calvaresi N, Armelloni S, Schmid H, Henger A, Ott U, et al. CD20-positive infiltrates in human membranous glomerulonephritis. J Nephrol 2005; 18: 328–333.
20. Bomback AS, Derebail VK, McGregor JG, Kshirsagar AV, Falk RJ, Nachman PH. Rituximab therapy for membranous nephropathy: a systematic review. Clin J Am Soc Nephrol 2009; 4: 734–44.
21. Remuzzi G, Chiurchiu C, Abbate M, Brusegan V, Bontempelli M, Ruggenenti P. Rituximab for idiopathic membranous nephropathy. Lancet 2002; 360: 923–924.
22. Ruggenenti P, Chiurchiu C, Brusegan V, Abbate M, Perna A, Filippi C, et al. Rituximab in idiopathic membranous nephropathy: A one-year prospective study. J Am Soc Nephrol 2003; 14: 1851–1857.
23. Lamprecht P, Lerin-Lozano C, Merz H, Dennin RH, Gause A, Voswinkel J, et al. Rituximab induces remission in refractory HCV associated cryoglobulinaemic vasculitis. Ann Rheum Dis 2003; 62:1230–3.
24. Zaja F, De Vita S, Mazzaro C, Sacco S, Damiani D, De Marchi G, et al. Efficacy and safety of rituximab in type II mixed cryoglobulinemia. Blood 2003; 101:3827–34.
25. Fakhouri F, Vernant JP, Veyradier A, Wolf M, Kaplanski G, Binaut R, et al. Efficiency of curative and prophylactic treatment with rituximab in ADAMTS13-deficient thrombotic thrombocytopenic purpura: a study of 11 cases. Blood 2005;106:1932–7.
Labels
Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
2009 Issue 3
Most read in this issue
- Treatment of patients with proximal femoral fractures. I. Orthopaedic care. Guidelines of the Czech Rheumatological Society and the Czech Society for Metabolic Bone Diseases
- Vascular endothelial growth factor in inflammatory rheumatic diseases
- Safety of biological therapy – Guidelines of the Czech Society for Rheumatology
- Concomitant fibromyalgia in patients with rheumatoid arthritis