We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Prospective study of the effect of rituximab on kidney function in membranous nephropathy.
- Authors
Kanigicherla, Durga A K; Kehagia, Angie A; Jamshidi, Babak; Manounah, Lina; Barnes, Anna; Patrick, Hannah; Powell, Helen; Austin, Catrin; Norton, Stephen; Willcocks, Lisa; Griffith, Megan; Braddon, Fiona; Steenkamp, Retha; McKane, William S; Khwaja, Arif
- Abstract
Background Patients with membranous nephropathy (MN) and poor kidney function or active disease despite previous immunosuppression are underrepresented in clinical trials. It is unknown how effective rituximab is in this population. Methods This prospective, multi-centre, single-arm, real-world study of patients with active MN [urine protein-creatinine ratio (uPCR) >350 mg/mmol and serum albumin <30 g/L, or a fall in estimated glomerular filtration rate (eGFR) of at least 20% or more over at least 3 months] evaluated rituximab in those with contraindications to calcineurin inhibitors and cytotoxic therapy. The primary outcome was change in rate of eGFR decline before and after rituximab. Complete or partial remission were defined as uPCR <30 mg/mmol or uPCR <350 mg/mmol with a ≥50% fall from baseline, respectively. Results A total of 180 patients [median age 59 years, interquartile range (IQR) 48–68] received rituximab and were followed up for a median duration of 17 months. Seventy-seven percent had prior immunosuppression. Median eGFR and uPCR at baseline were 49.2 mL/min/1.73 m2 (IQR 34.4–80.6) and 766 mg/mmol (IQR 487–1057), respectively. The annual rate of decline of eGFR fell from 13.9 to 1.7 mL/min/1.73 m2/year following rituximab (Z score = 2.48, P < .0066). At 18 months 12% and 42% of patients were in complete or partial remission, respectively. Rituximab was well tolerated; patient survival was 95.6% at 2 years and in patients in whom eGFR was available, kidney survival was 93% at 2 years. Conclusion Rituximab significantly reduced the rate of eGFR decline in active MN including those who had received prior immunosuppression or with poor baseline kidney function.
- Subjects
GLOMERULAR filtration rate; KIDNEY physiology; SERUM albumin; OVERALL survival; EPIDERMAL growth factor receptors; RITUXIMAB
- Publication
Clinical Kidney Journal, 2024, Vol 17, Issue 8, p1
- ISSN
2048-8505
- Publication type
Article
- DOI
10.1093/ckj/sfae179