Abstract: TH-PO212

Rituximab as Rescue Therapy for Difficult to Treat Lupus Nephritis: A Case Series

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Baynes-Fields, Jaime A., Drexel University , Philadelphia, Pennsylvania, United States
  • Lee, Al Jonathan, None, Philadelphia, Pennsylvania, United States
  • Kaur, Navneet, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
  • Aggarwal, Sandeep, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
Background

Conventional treatment of lupus nephritis with antimetabolites, calcineurin inhibitors, and steroids may be associated with intolerable adverse events or treatment resistance. We present a case series of patient characteristics and treatment response to rituximab therapy in three patients with resistance or intolerance to conventional lupus nephritis therapy at our center.

Methods

Patient data for three lupus nephritis patients who were treated with rituximab was obtained from retrospective chart review. Student t-test was used for comparison of means. Demographic serological, clinical characteristics and indications for rituximab therapy are presented in (Table 1). There was a non-statistically significant improvement between pre-rituximab serum creatinine (sCr) (1.26 ± 0.18 mg/dl) and post-rituximab sCr (1.00 ± 0.3 mg/dl, p=0.153) and pre and post rituximab degree of proteinuria (1664 ± 1278 vs 739 ± 595 mg/g, p=0.18). There was a statistically significant improvement in pre and post rituximab serum complement C3 (66 ± 45 vs 94 ± 42 mg/dl, p=0.003) and serum complement C4 levels (10.7 ± 5.5 vs 22.3 ± 11.2 mg/dl, p=0.04). The average time to treatment response, defined as 50% reduction in proteinuria, and serological increase in complement levels, was 7 months. There were no adverse events reported. There was a clinically significant reduction in immunosuppression and medication side effects as well as tolerance (Table 1).

Conclusion

In conclusion, rituximab as a “rescue” therapy was efficacious and well tolerated in our patients. More research is required to ascertain the clinical and serological characteristics of patients with lupus nephritis who may benefit from rituximab therapy.

Table 1: Demographic, Serological and Clinical characteristics
Case NumberDemographics: age(years), ethnicity, genderLupus Nephritis ClassPre-Rituximab Regimen,
Total daily dose in mg (miligrams)
Post-Rituximab Regimen,
Total daily dose in mg (miligrams)
Rituximab Indication**Time to Peak
Response (months)
Serology Profile
127, White, Female4Prednisone 10 mg
Mycophenolate 3000 mg
Tacrolimus 3 mg
Prednisone 1mg
Mycophenolate 1000 mg
Treatment failure,
osteoporosis, cushing syndrome
8ANA (-), dsDNA (-)
254, Black, Male4Prednisone 5 mg
Mycophenolate 2000mg - intolerant*
Azathoprine 100mg - intolerant*
Hydroxychloroquine 800mg
Prednisone 5mg Hydroxychloroquine 400mgMultiple infections, Treatment failure10ANA (+), dsDNA (+), RNP (+), SSa/SSb (+)
325, Black, Male4+5Prednisone 10 mg
Mycophenolate 2000 mg
Tacrolimus 3 mg
Prednisone 5 mg
Mycophenolate 2000mg
Tacrolimus 1.5 mg
Multiple infections, Treatment failure4ANA (+), dsDNA (+)

*Intolerance secondary to multiple infections (empyema, pyelonephritis) **All patients were given rituximab 1gram IV x 2 doses