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Abstract: SA-PO880

Efficacy of Rituximab in Long-Term Maintenance of Remission in Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Wang, Qiyu, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Zonozi, Reza, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Laliberte, Karen A., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Niles, John, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Jeyabalan, Anushya, Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Rituximab(RTX) is known to be effective in inducing remission in patients (pts) with refractory lupus nephritis (LN). However, utility of RTX as maintenance therapy remains unclear.

Methods

We analyzed clinical data of 19 pts with LN treated at MGH who received RTX as maintenance therapy for >=12 months(mos) after achieving complete/partial remission. Pts were followed from the date of first RTX infusion after remission(baseline) to 6 mos after their last dose of RTX or development of ESKD. Renal relapse, renal survival and effect of oral immunosuppression reduction were described.

Results

Among the 19 pts, the main indication for RTX maintenance therapy was prior treatment failure with mycophenolate(n=13). Mean age was 36 (IQR 25-43),18/19 pts were female,13/19 were white. Median creatinine(Cr) was 0.8mg/dL (IQR 0.7-1.4) and median proteinuria was 0.5g/g (IQR 0.3-1.0) at baseline.17 pts had class III/IV±V LN, 2 had pure class V LN. 6 renal relapses occurred in 5 pts during a median follow-up of 36 mos (IQR 24-71). All but 1 had B cell repopulation during relapse (Figure 1). 3 pts developed ESKD: all had advanced CKD at baseline(Cr >2mg/dL). 9/19(47%) pts were on RTX monotherapy at baseline,11/19(58%) at 12 mos, 8/12(67%) at 24 mos. Median prednisone dose was 5mg/day (IQR 0-7.5) at baseline and 0 at 12 and 24 mos (Figure 2). 2 pts discontinued RTX due to infection.

Conclusion

RTX may be an effective alternative for long-term maintenance of remission in LN.