AB0488 RITUXIMAB THERAPY IN LUPUS NEPHRITIS RESISTANT TO CONVENTIONAL THERAPY – A SINGLE CENTER EXPERIENCE (CASE SERIES)
Authors: Berna Yurttas, Bugra Han Egeli, Serdal Ugurlu
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Lupus nephritis(LN) can be a cause of morbidity and mortality in a significant portion of patients. The treatment of lupus nephritis can be challenging in some patients who are resistant to conventional immunosuppressive treatment. <h3>Objectives:</h3> Rituximab is a promising agent for treating resistant patients. We evaluated the response of lupus nephritis patients who were treated with rituximab treatment in our clinic retrospectively. <h3>Methods:</h3> We evaluated LN patients who were followed and treated with at least one course of rituximab in our clinic between 2013-2018. Remission was defined as proteinuria below 500 mg/day. Also, we evaluated the reason behind the cessation of rituximab during the follow-up whether it is a side effect or lack of efficacy. A final 24-hour proteinuria level was also analyzed at the end of the follow-up. <h3>Results:</h3> 33 patients (20 F, 13 M) were treated with rituximab. All patients had active lupus nephritis at initiation. Mean of disease duration was 6.7 years. Diagnosis was proven by renal biopsy, except two (Table). Patients received an average of 4.2 courses. All patients were treated with high dose steroids. The other medications, the patients were previously treated with, were Cyclophosphamide (n=26), Azathioprine (n=7), Mycophenolate mofetil (n=17). Also one patient was treated with plasmapheresis due to thrombotic thrombocytopenic purpura. 2 patients were lost in follow-up. 13 patients (39%) are still on rituximab. Six of them (46%) still have active LN. Among 18 patients in whom rituximab therapy was terminated, 3 had inadequate response, 2 had severe infection (cellulitis, pneumonia), 1 had Rituximab-induced serum sickness, 1 had will of pregnancy. Treatment of 11 patients was terminated owing to remission of disease. All of the patients whom rituximab was terminated in disease remission did not flare, except one. The mean level of pre-treatment proteinuria was 3356 ± 2478 mg/day. The mean level of proteinuria after the final course was 1025 ± 982 mg/day (p&lt;0,0001). Mean erythrocyte sedimentation rate (ESR) was reduced from 28,62 ± 22,95 mm/h to 14,97 ± 12,32 mm/h (p&lt;0,005). While initial steroid dose was 24 ± 19,3 mg/day, steroid dose at last rituximab course was 7,84 ± 6,13 mg/day (p&lt;0,0001). None of the patients had a new organ involvement during therapy. End stage renal disease was developed in 3 patients. During the treatment 7 patients had infections, 2 had herpes zoster, 1 had cellulitis, 3 had pneumoniae and 1 had frequent upper respiratory infections. <h3>Conclusion:</h3> In lupus nephritis patients resistant to conventional therapy, rituximab can be tried as an alternative treatment choice. In our single center, most of the patients were class IV nephritis whom we observed the efficacy of rituximab. Generally, the side effects were acceptable. Rituximab can be a steroid sparing agent in these patients. <h3>References</h3> [1] Iaccarino L, Bartoloni E, Carli L, Ceccarelli F, Conti F, De Vita S, Ferraccioli G, Galeazzi M, Gatto M, Gerli R, Govoni M, Gremese E, Iuliano A, Mansutti E, Moroni G, Mosca M, Nalli C, Naretto C, Padovan M, Palma L, Raffiotta F, Roccatello D, Tincani A, Valesini G, Zen M, Doria A. Efficacy and safety of off-label use of rituximab in refractory lupus: data from the Italian MulticentreRegistry. Clin Exp Rheumatol. 2015 Jul-Aug;33(4):449-56. <h3>Disclosure of Interests:</h3> None declared