10-year personal experience of rituximab use in nephrological patients

Abstract

The article presents 10-year authors’ experience of rituximab use in chronic kidney disease caused by glomerulonephritis, systemic lupus erythematosus, or vasculitis. Twenty-seven adult patients (34 ± 6 years, 10 (37 %) men, 17 (63 %) women, duration of renal disease 3.2 ± 0.3 years), 2 people with transplanted kidney and 6 children received rituximab at a dose of 1 g twice with an interval of 2 weeks and then after six months. The average dose of rituximab was 2.4 g per treatment course per patient. Twenty-three (86 %) individuals underwent nephrobiopsy, four (17 %) — twice, and one (4 %) person — three times, CD20-positive cells in the renal biopsy specimen were determined in 17 patients (74 %). Before the second injection of rituximab (6 months after the first injection), a blood serum CD20 was studied; in the presence of any number of cells or evidence for an active process, the dose of rituximab was repeated 1 g twice. Three patients (11 %) had an allergic reaction to the drug for 2.00 ± 0.25 hours. To control blood pressure in hypertensive patients, torasemide and moxo­nidine were additionally prescribed after administration of me­thylprednisolone. The therapy included administration of renin-angiotensin system inhibitors and diuretics. Two criteria were used to evaluate the effectiveness of rituximab therapy: the level of proteinuria (before treatment initiation it was 3.7 ± 1 g/day)
and estimated glomerular filtration rate (before treatment initiation it was 55.50 ± 3.33 ml/min). The overall effectiveness of rituximab treatment in achieving remission was 74 % among nephrological patients; however, it differed significantly in various nosological forms: it was highest in lupus nephritis (up to 80 %), in half of patients with focal segmental glomerulosclerosis and membranous nephropathy and was absolutely ineffective in granulomatosis with polyangiitis and Goodpasture syndrome. The prognostic significance of detecting CD20 in the renal biopsy specimen to justify the prescription of rituximab requires further researches; however, a large amount of CD20 is a prognostically unfavorable factor. Determination of CD20 in the blood can be an additional tool to justify the timing of the second/third administration of rituximab.