Remission of refractory lupus nephritis with a protocol including rituximab

• Published in: Lupus 2003-01, Vol.12 (10), p.783-787
• Main Authors: Fra, G P, Avanzi, G C, Bartoli, E
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents - administration & dosage; Cyclophosphamide - administration & dosage; Drug Therapy, Combination; Female; Glucocorticoids - administration & dosage; Humans; Immunosuppressive Agents - administration & dosage; Lupus Nephritis - drug therapy; Prednisone - administration & dosage; Proteinuria - drug therapy; Remission Induction; Rituximab
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1191/0961203303lu453cr

Immunosuppression with corticosteroids and cyclophosphamide is the standard of care for lupus nephritis. We report a 19-year old woman with lupus nephritis and nephrotic syndrome who had not achieved complete remission after treatment with 15.7g cyclophosphamideand 13.7g prednisone.We planned a consolidation phase with: 1) cyclophosphamide 20mg/kg i.v. every 28 days for three cycles; 2) anti-CD20 chimeric monoclonal antibody (rituximab) 375mg/m2 i.v. weekly for four weeks; and 3) slow tapering of prednisone p.o., q.o.d., after a reinduction dose during rituximab administration. At the end of this phase the patient achieved complete remission. An indefinite maintenance treatment with methotrexate, cyclosporin and low-dose prednisone was then started. Twenty-four months later the patient remains in remission. In the immunosuppressive treatment of lupusnephritisthe insertionof a consolidationphasewith rituximab combinedwith cyclophosphamide achieves a therapeutically important and lasting deletion of the lymphocyte clone responsible for autoimmunity.