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Abstract: FR-PO873

Long-Term Outcomes of Rituximab Treatment in Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Nikolopoulou, Aikaterini K., Imperial College London, London, United Kingdom
  • Teixeira, Ana Catarina, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
  • McAdoo, Stephen Paul, Imperial College London, London, United Kingdom
  • Levy, Jeremy B., Imperial College Healthcare NHS Trust, London, United Kingdom
  • Tam, Frederick W.K., Imperial College Kidney and Transplant Institute, London, United Kingdom
  • Lightstone, Liz, Imperial College London, London, United Kingdom
  • Cairns, Tom, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Pusey, Charles D., Imperial College London, London, United Kingdom
  • Griffith, Megan, Imperial College Healthcare NHS Trust, London, United Kingdom
Background

Rituximab is increasingly used for the treatment of membranous nephropathy (MN), both as first line & for relapsing disease, but there are few published data on long term outcomes.

Methods

In this retrospective, observational cohort study we report outcomes of 38 adult patients with biopsy proven MN treated with rituximab between Jan 2008 & Jan 2018. Follow up was for a mean of 4 years (range 1-10). Rituximab, 2 x 1 g doses, was administered at days 0 & 14.

Results

We identified 38 patients, 25 male, median age 57.5yrs (range 23-77). At administration of rituximab, patients were heavily nephrotic with median urinary protein creatinine ratio (uPCR) 851 mg/mmol (range 574-1420) & median eGFR 33 ml/min/1.73m2 (23-59). B cell depletion occurred within 2 weeks of administration; however, 73% of patients were B cell replete at 3 months.
By latest f/up, 27 (71%) patients achieved remission (CR & PR). Median time to PR was 12 mths but CR took longer to achieve, up to 36 mths in some cases. Relapses occurred in 5 (18.5%) responders, of whom 1 died & 1 progressed to ESRD.
There were 11 (29%) non-responders of whom 7 progressed to ESKD.
The eGFR was less than 30ml/min/1.73m2 in 17 patients (44.7%) at the time of rituximab treatment. Whilst 7 of these patients progressed to ESKD, in 10 cases renal function improved or stabilised.
3 patients died during the follow up period one from intracerebral haemorrhage, one from lung malignancy & one from a cardiac event.

Conclusion

Rituximab is effective in treating MN though the time to remission can be prolonged. B cell repletion occurs early in MN however this is not necessarily associated with relapse.
Importantly, response to rituximab can lead to preservation or improvement of renal function even when severely impaired. Such patients may benefit from treatment and should not necessarily be excluded from controlled trials.