TY - JOUR
T1 - Rituximab in idiopathic membranous nephropathy
T2 - A one-year prospective study
AU - Ruggenenti, Piero
AU - Chiurchiu, Carlos
AU - Brusegan, Varusca
AU - Abbate, Mauro
AU - Perna, Annalisa
AU - Filippi, Claudia
AU - Remuzzi, Giuseppe
PY - 2003/7/1
Y1 - 2003/7/1
N2 - Currently available monoclonal antibodies against the B cell surface antigen CD20 have been employed to explore whether specific inhibition of B cells may help improve the outcome of idiopathic membranous nephropathy (IMN) and may avoid the side effects of steroids and immunosuppressants. This prospective, observational study evaluated the 1-yr outcome of eight IMN patients with persistent (>6 mo) urinary protein excretion > 3.5 g/24 h given four weekly infusions of the anti-CD20 antibody rituximab (375 mg/m2) At 3 and 12 mo, proteinuria significantly decreased from mean (± SD) 8.6 ± 4.2 to 4.3 ± 3.3 (-51%, P <0.005) and 3.0 ± 2.5 (-66%, P <0.005) g/24 h, albumin fractional clearance from 2.3 ± 2.1 to 1.2 ± 1.7 (-47%, P <0.05) and 0.5 ± 0.6 (-76%, P <0.003), and serum albumin concentration increased from 2.7 ± 0.5 to 3.1 ± 0.3 (+21%, P <0.05) and 3.5 ± 0.4 (+41%, P <0.05) mg/dl. At 12 mo, proteinuria decreased to ≤0.5 g/24 h or ≤3.5 g/24 h in two and three patients, respectively. Proteinuria decreased in the remaining patients by 74%, 44%, and 41%, respectively. Body weight, diastolic BP, and serum cholesterol progressively decreased in parallel with an improvement of edema in all patients. Renal function stabilized (Δl/creatinine: +0.002 ± 0.007). CD20 B lymphocytes fell below normal ranges up to study-end. No patient had major drug-related events or major changes in other laboratory parameters. Rituximab thus promotes sustained disease remission in patients otherwise predicted to progress to ESRD, and it is safe. The long-term risk/benefit profile of this novel, disease-specific approach seems much more favorable to that of commonly employed immunosuppressive drugs.
AB - Currently available monoclonal antibodies against the B cell surface antigen CD20 have been employed to explore whether specific inhibition of B cells may help improve the outcome of idiopathic membranous nephropathy (IMN) and may avoid the side effects of steroids and immunosuppressants. This prospective, observational study evaluated the 1-yr outcome of eight IMN patients with persistent (>6 mo) urinary protein excretion > 3.5 g/24 h given four weekly infusions of the anti-CD20 antibody rituximab (375 mg/m2) At 3 and 12 mo, proteinuria significantly decreased from mean (± SD) 8.6 ± 4.2 to 4.3 ± 3.3 (-51%, P <0.005) and 3.0 ± 2.5 (-66%, P <0.005) g/24 h, albumin fractional clearance from 2.3 ± 2.1 to 1.2 ± 1.7 (-47%, P <0.05) and 0.5 ± 0.6 (-76%, P <0.003), and serum albumin concentration increased from 2.7 ± 0.5 to 3.1 ± 0.3 (+21%, P <0.05) and 3.5 ± 0.4 (+41%, P <0.05) mg/dl. At 12 mo, proteinuria decreased to ≤0.5 g/24 h or ≤3.5 g/24 h in two and three patients, respectively. Proteinuria decreased in the remaining patients by 74%, 44%, and 41%, respectively. Body weight, diastolic BP, and serum cholesterol progressively decreased in parallel with an improvement of edema in all patients. Renal function stabilized (Δl/creatinine: +0.002 ± 0.007). CD20 B lymphocytes fell below normal ranges up to study-end. No patient had major drug-related events or major changes in other laboratory parameters. Rituximab thus promotes sustained disease remission in patients otherwise predicted to progress to ESRD, and it is safe. The long-term risk/benefit profile of this novel, disease-specific approach seems much more favorable to that of commonly employed immunosuppressive drugs.
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U2 - 10.1097/01.ASN.0000071511.35221.B3
DO - 10.1097/01.ASN.0000071511.35221.B3
M3 - Article
C2 - 12819245
AN - SCOPUS:0038544639
VL - 14
SP - 1851
EP - 1857
JO - Journal of the American Society of Nephrology : JASN
JF - Journal of the American Society of Nephrology : JASN
SN - 1046-6673
IS - 7
ER -