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Clinical Nephrology
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Titrating Rituximab to Circulating B Cells to Optimize Lymphocytolytic Therapy in Idiopathic Membranous Nephropathy

Paolo Cravedi, Piero Ruggenenti, Maria Chiara Sghirlanzoni and Giuseppe Remuzzi
CJASN September 2007, 2 (5) 932-937; DOI: https://doi.org/10.2215/CJN.01180307
Paolo Cravedi
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Piero Ruggenenti
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Maria Chiara Sghirlanzoni
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Giuseppe Remuzzi
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Abstract

Background and Objectives: Rituximab, given in four weekly doses, is a promising treatment for idiopathic membranous nephropathy and other immune-mediated diseases and lymphoproliferative disorders. This multidose regimen, however, may cause hypersensitivity reactions and is extremely expensive. This study was aimed at evaluating whether titrating rituximab to circulating CD20 B cells may improve safety and limit costs of treatment.

Design, Setting, Participants, & Measurements: In a matched-cohort, single-center, controlled study, the outcome of 12 new incident patients who had idiopathic membranous nephropathy and nephrotic syndrome and received a B cell–driven treatment was compared with that of 24 historical reference patients who were given the standard protocol of four weekly doses of 375 mg/m2.

Results: Only one patient needed a second dose to achieve full CD20 cell depletion. At 1 yr, time course of the components of nephrotic syndrome and the proportion of patients who achieved disease remission (25%) was identical in both groups. Persistent CD20 cell depletion was achieved in all patients. Costs for rituximab treatment and hospitalizations totalled €3770.90 ($4902.20) and €13,977.60 ($18,170.80) with the B cell–driven and the four-dose protocol, respectively. One patient on standard protocol had a severe adverse reaction at second rituximab dose. Thus, B cell titrated as effectively as standard rituximab treatment achieves B cell depletion and idiopathic membranous nephropathy remission but is fourfold less expensive, allowing for more than €10,000, approximately $13,000 in savings per patient.

Conclusions: Avoiding unnecessary reexposure to rituximab is extremely cost-saving and may limit the production of antichimeric antibodies that may increase the risk for adverse reactions and prevent re-treatment of disease recurrences.

  • Received March 9, 2007.
  • Accepted June 19, 2007.
  • Copyright © 2007 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology
Vol. 2, Issue 5
September 2007
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Titrating Rituximab to Circulating B Cells to Optimize Lymphocytolytic Therapy in Idiopathic Membranous Nephropathy
Paolo Cravedi, Piero Ruggenenti, Maria Chiara Sghirlanzoni, Giuseppe Remuzzi
CJASN Sep 2007, 2 (5) 932-937; DOI: 10.2215/CJN.01180307

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Titrating Rituximab to Circulating B Cells to Optimize Lymphocytolytic Therapy in Idiopathic Membranous Nephropathy
Paolo Cravedi, Piero Ruggenenti, Maria Chiara Sghirlanzoni, Giuseppe Remuzzi
CJASN Sep 2007, 2 (5) 932-937; DOI: 10.2215/CJN.01180307
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  • Clinical Response and Pattern of B cell Suppression with Single Low Dose Rituximab in Nephrology
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  • Rituximab in Steroid-Dependent or Frequently Relapsing Idiopathic Nephrotic Syndrome
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  • Overcoming Calcineurin Dependence in Membranous Nephropathy: Is Rituximab the Answer?
  • Rituximab Therapy for Membranous Nephropathy: A Systematic Review
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