Rituximab in nephrologist’s hands – first experience
Authors:
Z. Hrušková 1,2; H. Marečková 2; E. Jančová 1; R. Ryšavá 1; V. Tesař 1
Authors‘ workplace:
Klinika nefrologie VFN a 1. LF UK v Praze, 2Ústav imunologie a mikrobiologie VFN a 1. LF UK v Praze
1
Published in:
Čes. Revmatol., 17, 2009, No. 3, p. 127-133.
Category:
Original Papers
Overview
In nephrologic patients refractory to standard combined immunosuppressive therapy, or in those not tolerating it, biological therapy, including rituximab, has recently become a possible alternative. Rituximab (RTX) is a chimeric monoclonal antibody against the antigen CD20. Administration of RTX causes a selective transient depletion of B lymphocytes. In this article, our present experience with the use of RTX is summarized and commented. In our department, RTX has been so far administered to 17 patients with various nephrologic diagnoses (7x ANCA associated vasculitis - AAV, 5x systemic lupus erythematosus - SLE, 2x cryoglobulinaemia associated with hepatitis C virus infection - KG, 2x membranous nephropathy - MGN, 1x thrombotic thrombocytopenic purpura – TTP). In 7 patients, 4x375 g/m2 of rituximab was administered weekly. In 10 patients, the dose used was 1 g each separated by 2 weeks. Out of 15 patients with a follow-up longer than 1 year, at least partial remission has been achieved in all treated patients with SLE, KG and TTP, and also in some patients with AAV. In AAV patients with predominant granulomatous involvement, and in patients with MGN, the treatment with RTX was not successful. RTX was well tolerated in most patients; mild adverse events (fever, chills) were observed in 3 out of 17 patients (18%). Thus, rituximab seems to be a safe and effective drug in the therapy of some nephrologic diseases, even though the results of larger trials, which would unambiguously answer the questions of proper indications, the best administration strategy, possibility of repeated treatment and long-term safety, are still missing.
Key words:
biological therapy, glomerulonephritis, monoclonal antibody, refractory disease, rituximab
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