Treatment with rituximab in idiopathic membranous nephropathy.
Treatment with rituximab in idiopathic membranous nephropathy.
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DOI：
10.1093/ckj/sfw091
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发表时间：
2016-12
影响因子：
4.6
通讯作者：
Manno C
中科院分区：
文献类型：
--
作者：
Fiorentino M;Tondolo F;Bruno F;Infante B;Grandaliano G;Gesualdo L;Manno C
利妥昔单抗是诱导原发性肾小球肾炎患者缓解的有效治疗选择。尽管有几项研究证明它能改善膜性肾病(MN)患者的预后，但它在治疗方案中的作用尚未确定。我们研究了38例使用利妥昔单抗治疗的特发性MN患者(其中13例作为一线治疗，其余25例在常规免疫抑制治疗后)。对这些患者进行了15个月的中位(四分位数范围7.7-30.2)随访，并对24小时蛋白尿、肾功能和循环CD19+B细胞进行了连续监测。获得完全缓解、部分缓解和复合终点(完全或部分缓解)的患者分别为39.5%(15例)、36.8%(14例)和76.3%(29例)。在整个随访期间，24小时蛋白尿显著减少(从上次访问的基准值6.1克/天降至0.9克/天；P<；0.01)，而蛋白血症持续上升(上次观察时从2.6克/分升至3.5克/分升；P<；0.01)。肾功能在观察期内无明显变化。循环CD19+B细胞较治疗前显著下降(P<；0.01)；14例患者有抗磷脂酶A2受体抗体的数据，其中10例治疗后有下降趋势。在输液过程中和输液后没有重大不良事件的描述。目前的研究证实，利妥昔单抗治疗MN是非常安全的，并允许MN患者获得很大比例的完全或部分缓解。
Rituximab represents a valid therapeutic option to induce remission in patients with primary glomerulonephritis. Despite several studies proving its efficacy in improving outcomes in patients with membranous nephropathy (MN), its role in therapeutic protocols is not yet defined. We studied 38 patients with idiopathic MN treated with rituximab (in 13 patients as first-line therapy, in the remaining 25 after conventional immunosuppressive therapy). The patients were analyzed for a 15-month median (interquartile range 7.7–30.2) follow-up, with serial monitoring of 24-h proteinuria, renal function and circulating CD19+ B cells. The percentages of patients who achieved complete remission, partial remission and the composite endpoint (complete or partial remission) were 39.5% (15 patients), 36.8% (14 patients) and 76.3% (29 patients), respectively. The 24-h proteinuria was reduced significantly during the entire period of follow-up (from a baseline value of 6.1 to 0.9 g/day in the last visit; P < 0.01), while albuminemia increased constantly (from a baseline value of 2.6 to 3.5 g/dL in the last observation; P < 0.01). Renal function did not significantly change during the observation period. Circulating CD19+ B cells were reduced significantly from the baseline value to the 24-month value (P < 0.01); data about anti-phospholipase A2 receptor antibodies were available in 14 patients, 10 of which experienced a decreasing trend after treatment. No significant adverse events were described during and after infusions. The present study confirmed that treatment with rituximab was remarkably safe and allowed for a large percentage of complete or partial remissions in patients with MN.