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Clinical Nephrology
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Successful Treatment of Membranous Glomerulonephritis with Rituximab in Calcineurin Inhibitor-Dependent Patients

Alfons Segarra, Manuel Praga, Natalia Ramos, Natalia Polanco, Isabel Cargol, Elena Gutierrez-Solis, M. Rosa Gomez, Bruno Montoro and Joaquim Camps
CJASN June 2009, 4 (6) 1083-1088; DOI: https://doi.org/10.2215/CJN.06041108
Alfons Segarra
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Manuel Praga
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Natalia Ramos
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Natalia Polanco
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Isabel Cargol
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Elena Gutierrez-Solis
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M. Rosa Gomez
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Bruno Montoro
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Joaquim Camps
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Abstract

Background and objectives: Calcineurin inhibitors (CNIs) induce remission of proteinuria in most nephrotic patients with membranous glomerulonephropathy (MGN). However, 60% of patients become treatment dependent and are at risk of chronic nephrotoxicity. The aim of this study was to evaluate the efficacy of rituximab in patients with long-term dependence on CNIs.

Design, setting, participants, and measurements: Thirteen patients with MGN, normal renal function, and proven dependence on CNIs, despite previous treatment with other immunosuppressant drugs, received a single trial of four weekly doses of rituximab (375 mg/m2). Outcome measures were the percentage of patients with CNI withdrawal and no evidence of relapse and the percentage of patients with complete or partial remission 30 mo after CNI withdrawal.

Results: After rituximab, proteinuria decreased significantly (2.5 ± 0,76 basal versus 0.85 ± 0.17 at 6 mo; P = .0003). CNIs and other immunosuppressant drugs could be withdrawn in all patients with no evidence of relapse. After CNI withdrawal, GFR increased significantly (90.3 ± 15 basal to 106.4 ± 20 at 3 mo with a mean increase of 15.3% [range 0–20]). Three patients suffered a relapse of nephrotic proteinuria 19, 23, and 28 mo after rituximab treatment; all were successfully treated with a second course of rituximab. At 30 mo, all patients were in remission.

Conclusions: In patients with MGN with long-term CNI dependence, rituximab can be an effective tool to overcome dependence on CNI, thus avoiding the risk of nephrotoxicity related to the chronic exposure to these drugs.

  • Received November 22, 2008.
  • Accepted April 9, 2009.
  • Copyright © 2009 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology
Vol. 4, Issue 6
June 2009
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Successful Treatment of Membranous Glomerulonephritis with Rituximab in Calcineurin Inhibitor-Dependent Patients
Alfons Segarra, Manuel Praga, Natalia Ramos, Natalia Polanco, Isabel Cargol, Elena Gutierrez-Solis, M. Rosa Gomez, Bruno Montoro, Joaquim Camps
CJASN Jun 2009, 4 (6) 1083-1088; DOI: 10.2215/CJN.06041108

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Successful Treatment of Membranous Glomerulonephritis with Rituximab in Calcineurin Inhibitor-Dependent Patients
Alfons Segarra, Manuel Praga, Natalia Ramos, Natalia Polanco, Isabel Cargol, Elena Gutierrez-Solis, M. Rosa Gomez, Bruno Montoro, Joaquim Camps
CJASN Jun 2009, 4 (6) 1083-1088; DOI: 10.2215/CJN.06041108
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Cited By...

  • Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy
  • Circulating Anti-PLA2R Autoantibodies to Monitor Immunological Activity in Membranous Nephropathy
  • Antigen Identification in Membranous Nephropathy Moves toward Targeted Monitoring and New Therapy
  • Overcoming Calcineurin Dependence in Membranous Nephropathy: Is Rituximab the Answer?
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