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Abstract: FR-PO874

Long-Term Outcome of Treatment of Relapsing Primary Membranous Nephropathy with Rituximab

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Margeta, Ivan, University Hospital Merkur, Zagreb, Croatia
  • Vucur, Ksenija, University Hospital Merkur, Zagreb, Croatia
  • Kozmar, Ana, University Hospital Centre Zagreb, Zagreb, Croatia
  • Knotek, Mladen, University Hospital Merkur, Zagreb, Croatia
Background

Primary membranous nephropathy is often susceptible to relapse after treatment with usual immunosuppresive therapy constisting of cyclophosphamide and glucocorticoids, or a calcineurin-inhibitor with glucocorticoids. Patients with relapse may be treated with rituximab. However its dose, frequency of administration and effect on long-term outcome have been incompletely evaluated.

Methods

Fourteen patients from our hospital were included in this study. The data were retrospectively extracted. Primary membranous nephropathy was diagnosed after exclusion of secondary causes, with finding of subepithelial deposits on electron-microscopy ± anti PLA2R antibodies. The inclusion criterion was relapse of a primary membranous nephropathy following a calcineurin inhibitor- or cyclophosphamide-based treatment. Patients recieved a single dose of intravenous rituximab (500 or 1000 mg), with target B-cell count < 5/µL. Subsequent courses of rituximab were administered following a repeat relapse.

Results

Ten patients were male and 4 female. The median age at time of diagnosis was 49 years (IQR 39-57 months). Median time from diagnosis to rituximab treatment was 17 months (IQR 10-41). During the median follow-up period of 47 months (IQR 32-68 months) 8 patients recieved one course of rituximab, 4 patients two courses and 2 patients three courses. Median time between two courses of rituximab was 16 months (IQR 6-26). Relapses following rituximab treatment responded to a repeat course of rituximab. There was a significant reduction in proteinuria from date of first rituximab treatment to date last seen (4±2.2 vs 1.1±1.1 grams, p<0.001), while there was no significant difference in serum creatinine (124±45 vs 102±21 µmol/L). Two patients had severe infective complications after rituximab treatment.

Conclusion

Rituximab is a safe and effective option in long-term treatment of relapsing primary membranous nephropathy.