What is the role of rituximab in the treatment of lupus nephritis?

Updated: Feb 08, 2021
  • Author: Lawrence H Brent, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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B-lymphocytes play a pivotal role in the pathogenesis of SLE, which makes rituximab, a B-lymphocyte–depleting therapy, an attractive therapeutic option in SLE and lupus nephritis. [70]  In meta-analyses, rituximab has proved effective, especially in lupus nephritis that is refractory to standard therapy. [71]  Most of the studies have been retrospective, but one prospective observational single-center cohort study demonstrated the efficacy of a steroid-sparing regimen of rituximab and mycophenolate mofetil for lupus nephritis. For the study, Condon et al treated 50 consecutive patients 2 doses of rituximab (1 g) and methylprednisolone (500 mg) on days 1 and 15, and mycophenolate mofetil for maintenance therapy. By 52 weeks, 52% of patients had achieved complete biochemical remission and 34% had achieved partial remission. [72]

However, despite wide clinical use, rituximab remains a controversial choice for lupus nephritis, due to the lack of robust supporting evidence and some negative results. For example, a randomized, double-blind, phase II/III trial of rituximab in moderately-to-severely active SLE (EXPLORER) failed to show differences compared with placebo, although a beneficial effect of rituximab was noted in the African-American and Hispanic subgroups. [73]   A randomized, double-blind, phase III trial of rituximab in active proliferative lupus nephritis (LUNAR) showed that rituximab therapy resulted in more responders and greater reductions in anti-DNA antibodies in increases in C3 and C4 levels, but it did not improve clinical outcomes after 1 year of treatment. [74]

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