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Abstract: FR-PO875

Low-Dose Rituximab Monotherapy Alone or in Combination with Tacrolimus Is Effective in Primary Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Author

  • Pathak, Vivek, Kovai Medical Center and Hospital, Coimbatore, Tamilnadu, India
Background

Previous therapies though effective had more adverse events.Rituximab has been used to induce remission in doses of 2gms.It was therefore used in our patients with lower doses alone or in combination with Tacrolimus to achieve remmission.This is a retrospective study to evaluate the role of this treatment.

Methods

15 patients aged 28 -72 years underwent treatment between since 2014 till 2018.Patients whose GFR was <40ml/min/1/73m2 were excluded from the study.Rituximab was given as a fixed dose of 500mg each.It was repeated if there was no response at 3 months.Rituximab was given as a monotherapy for 9 patients.Tacrolimus was added in 4/9 patients at the end of 3 months because of poor response.Rituximab and Tacrolimus were started together in 6 patients and out of these 2 were treated outside with modified Ponticelli regimen and had failed to show a response.Tacrolimus was given for 18 months.Complete remmission was defined as reduction in proteinuria of lessthan 0.3gms and partial remmission as less than 3gms or more than 50% reduction.

Results

Rituximab caused complete remmission in 4/ 9 patients and 1 patient attained partial remmission in the mean time of 8 months.2 patients attained remmission with the single dose of 500mg while another 2 required 2 doses of 500mg each.There was one relapse in this group who responded to one more dose of 500mg.Tacrolimus was added in 4 remaining patients at the end of 3 months.2 went into complete remmission after 3 months and one went into partial remmmission and one failed to respond.Tacrolimus was started along with first dose of Rituximab in 6 patients.2 patients received a single dose of 500mg, 2 received 500mg 2 doses and 1 received 3 doses of 500mg and 1 received 4 doses of 500mg.All went into complete remmission by mean time of 9 months.2 patients had relapses and both were sucessfully treated with 500mg of Rituximab.There was no fatal event in any group.There was only 1 patient who failed to respond to Rituximab and Tacrolimus combined therapy and subsequently responded to steroid and cyclophosphamide therapy.

Conclusion

Complete remmission was attained with a single dose of 500mg Rituximab monotherapy in 2 patients.This study showed complete or partial remmission in 14 /15 patients with this novel regimen with reduced side effects and cost by avoiding higher doses of Rituximab used in previous studies.