Rituximab Therapy in Chinese Patients with Lupus Nephritis

Shu-Hung Wang, Chang-Youh Tsai, Yu-Sheng Chang, Wei-Sheng Chen, Chung-Tei Chou

Research output: Contribution to journalArticle

Abstract

Background: Systemic lupus erythematosus (SLE) is a common autoimmune disease in Chinese, and there is high morbidity and mortality in patients with initial renal involvement or severe nephritis. We investigated the efficacy of B cell depletion therapy with rituximab as treatment of Chinese patients with lupus nephritis (LN).Methods: We enrolled 14 patients with lupus nephritis (LN) from Taipei Veterans General Hospital beginning in 2009. LN was confirmed by clinical and laboratory evaluation. Rituximab was indicated when a patient had proteinuria ( >1 g/day urinary protein) that was poorly responsive to treatment with corticosteroids or immunosuppressants. Laboratory examination, including measurements of CBC, creatinine, albumin, C3, C4, anti-dsDNA antibodies, and urinary protein, were performed before rituximab infusion and at 3-month and 6-month follow-ups. Intravenous rituximab was given twice over 2 weeks at a total dosage of 1 or 2 g. The primary endpoint was renal response status at week 24.Results: A total of 14 patients were enrolled from 2009 to 2011. There were 11 females and 3 males and the age range was 18 to 41 years (median: 31 years, IQR 10.5 years). The median urinary protein was 3.38 g/day (IQR: 1.76 to 6.47) before rituximab infusion, and was 1.25 g/day (IQR: 0.49-3.13) at the 6 month follow-up. At week 24, the overall renal response rate (complete + partial response) was 57% (8 of 14 patients). There were improvements in C3 levels (>20 mg/dL) in 6 patients (43%), improvements in C4 levels (>10 mg/dL) in 3 patients (21%), and reductions in anti-dsDNA antibody levels (>50%) in 8 patients (57%).Conclusion: Rituximab appeared to have acceptable efficacy in our group of 14 LN patients. Future controlled studies should examine the long-term safety and efficacy of rituximab and determine the optimal rituximab regimen for Chinese patients with LN.
Original languageEnglish
Pages (from-to)41-46
Number of pages6
JournalFormosan Journal of Rheumatology
Volume27
Issue number1
DOIs
Publication statusPublished - Sep 1 2013
Externally publishedYes

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Lupus Nephritis
Therapeutics
Kidney
Anti-Idiotypic Antibodies
Rituximab
Veterans Hospitals
Proteins
Nephritis
Immunosuppressive Agents
Cell- and Tissue-Based Therapy
Proteinuria
General Hospitals
Systemic Lupus Erythematosus
Autoimmune Diseases
Albumins
Creatinine
Adrenal Cortex Hormones
B-Lymphocytes
Morbidity

Keywords

  • 莫須瘤
  • 狼瘡腎炎
  • Rituximab
  • lupus nephritis

Cite this

Rituximab Therapy in Chinese Patients with Lupus Nephritis. / Wang, Shu-Hung; Tsai, Chang-Youh; Chang, Yu-Sheng; Chen, Wei-Sheng; Chou, Chung-Tei.

In: Formosan Journal of Rheumatology, Vol. 27, No. 1, 01.09.2013, p. 41-46.

Research output: Contribution to journalArticle

Wang, Shu-Hung ; Tsai, Chang-Youh ; Chang, Yu-Sheng ; Chen, Wei-Sheng ; Chou, Chung-Tei. / Rituximab Therapy in Chinese Patients with Lupus Nephritis. In: Formosan Journal of Rheumatology. 2013 ; Vol. 27, No. 1. pp. 41-46.
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abstract = "Background: Systemic lupus erythematosus (SLE) is a common autoimmune disease in Chinese, and there is high morbidity and mortality in patients with initial renal involvement or severe nephritis. We investigated the efficacy of B cell depletion therapy with rituximab as treatment of Chinese patients with lupus nephritis (LN).Methods: We enrolled 14 patients with lupus nephritis (LN) from Taipei Veterans General Hospital beginning in 2009. LN was confirmed by clinical and laboratory evaluation. Rituximab was indicated when a patient had proteinuria ( >1 g/day urinary protein) that was poorly responsive to treatment with corticosteroids or immunosuppressants. Laboratory examination, including measurements of CBC, creatinine, albumin, C3, C4, anti-dsDNA antibodies, and urinary protein, were performed before rituximab infusion and at 3-month and 6-month follow-ups. Intravenous rituximab was given twice over 2 weeks at a total dosage of 1 or 2 g. The primary endpoint was renal response status at week 24.Results: A total of 14 patients were enrolled from 2009 to 2011. There were 11 females and 3 males and the age range was 18 to 41 years (median: 31 years, IQR 10.5 years). The median urinary protein was 3.38 g/day (IQR: 1.76 to 6.47) before rituximab infusion, and was 1.25 g/day (IQR: 0.49-3.13) at the 6 month follow-up. At week 24, the overall renal response rate (complete + partial response) was 57{\%} (8 of 14 patients). There were improvements in C3 levels (>20 mg/dL) in 6 patients (43{\%}), improvements in C4 levels (>10 mg/dL) in 3 patients (21{\%}), and reductions in anti-dsDNA antibody levels (>50{\%}) in 8 patients (57{\%}).Conclusion: Rituximab appeared to have acceptable efficacy in our group of 14 LN patients. Future controlled studies should examine the long-term safety and efficacy of rituximab and determine the optimal rituximab regimen for Chinese patients with LN.",
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AU - Wang, Shu-Hung

AU - Tsai, Chang-Youh

AU - Chang, Yu-Sheng

AU - Chen, Wei-Sheng

AU - Chou, Chung-Tei

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N2 - Background: Systemic lupus erythematosus (SLE) is a common autoimmune disease in Chinese, and there is high morbidity and mortality in patients with initial renal involvement or severe nephritis. We investigated the efficacy of B cell depletion therapy with rituximab as treatment of Chinese patients with lupus nephritis (LN).Methods: We enrolled 14 patients with lupus nephritis (LN) from Taipei Veterans General Hospital beginning in 2009. LN was confirmed by clinical and laboratory evaluation. Rituximab was indicated when a patient had proteinuria ( >1 g/day urinary protein) that was poorly responsive to treatment with corticosteroids or immunosuppressants. Laboratory examination, including measurements of CBC, creatinine, albumin, C3, C4, anti-dsDNA antibodies, and urinary protein, were performed before rituximab infusion and at 3-month and 6-month follow-ups. Intravenous rituximab was given twice over 2 weeks at a total dosage of 1 or 2 g. The primary endpoint was renal response status at week 24.Results: A total of 14 patients were enrolled from 2009 to 2011. There were 11 females and 3 males and the age range was 18 to 41 years (median: 31 years, IQR 10.5 years). The median urinary protein was 3.38 g/day (IQR: 1.76 to 6.47) before rituximab infusion, and was 1.25 g/day (IQR: 0.49-3.13) at the 6 month follow-up. At week 24, the overall renal response rate (complete + partial response) was 57% (8 of 14 patients). There were improvements in C3 levels (>20 mg/dL) in 6 patients (43%), improvements in C4 levels (>10 mg/dL) in 3 patients (21%), and reductions in anti-dsDNA antibody levels (>50%) in 8 patients (57%).Conclusion: Rituximab appeared to have acceptable efficacy in our group of 14 LN patients. Future controlled studies should examine the long-term safety and efficacy of rituximab and determine the optimal rituximab regimen for Chinese patients with LN.

AB - Background: Systemic lupus erythematosus (SLE) is a common autoimmune disease in Chinese, and there is high morbidity and mortality in patients with initial renal involvement or severe nephritis. We investigated the efficacy of B cell depletion therapy with rituximab as treatment of Chinese patients with lupus nephritis (LN).Methods: We enrolled 14 patients with lupus nephritis (LN) from Taipei Veterans General Hospital beginning in 2009. LN was confirmed by clinical and laboratory evaluation. Rituximab was indicated when a patient had proteinuria ( >1 g/day urinary protein) that was poorly responsive to treatment with corticosteroids or immunosuppressants. Laboratory examination, including measurements of CBC, creatinine, albumin, C3, C4, anti-dsDNA antibodies, and urinary protein, were performed before rituximab infusion and at 3-month and 6-month follow-ups. Intravenous rituximab was given twice over 2 weeks at a total dosage of 1 or 2 g. The primary endpoint was renal response status at week 24.Results: A total of 14 patients were enrolled from 2009 to 2011. There were 11 females and 3 males and the age range was 18 to 41 years (median: 31 years, IQR 10.5 years). The median urinary protein was 3.38 g/day (IQR: 1.76 to 6.47) before rituximab infusion, and was 1.25 g/day (IQR: 0.49-3.13) at the 6 month follow-up. At week 24, the overall renal response rate (complete + partial response) was 57% (8 of 14 patients). There were improvements in C3 levels (>20 mg/dL) in 6 patients (43%), improvements in C4 levels (>10 mg/dL) in 3 patients (21%), and reductions in anti-dsDNA antibody levels (>50%) in 8 patients (57%).Conclusion: Rituximab appeared to have acceptable efficacy in our group of 14 LN patients. Future controlled studies should examine the long-term safety and efficacy of rituximab and determine the optimal rituximab regimen for Chinese patients with LN.

KW - 莫須瘤

KW - 狼瘡腎炎

KW - Rituximab

KW - lupus nephritis

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DO - 10.6313/FJR.2013.27

M3 - Article

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SP - 41

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JO - Formosan Journal of Rheumatology

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SN - 2075-0374

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