Objective. We report the first comparison between rituximab (RTX) and either MMF or CYC pulses in the treatment of active LN. Methods. Fifty-four patients with active LN received three methylprednisolone pulses for 3 consecutive days followed by oral prednisone and RTX 1 g at days 3 and 18 (17 patients) or MMF 2-2.5 g/day (17 patients) or six CYC pulses (0.5 g every fortnight) (20 patients). At 4 months MMF, AZA or ciclosporin were associated to prednisone as a consolidation/maintenance therapy in all groups. The outcomes of the three groups were compared at 3 and 12 months. Results. Patients in the RTX group were older, had a longer duration of SLE and LN, had more renal flares, had higher activity and had higher chronicity indexes at renal biopsy than the other two groups. Four patients in each group had acute renal dysfunction and ∼50% had nephrotic syndrome. At 3 months, proteinuria was reduced by 50% in 58.8% of patients on RTX, in 64.7% on MMF and in 63.1% on CYC. At 12 months, complete remission was present in 70.6% of patients on RTX, in 52.9% on MMF, and in 65% on CYC. Partial remission was reached in 29.4% on RTX, 41.2% on MMF, and 25% on CYC. Conclusion. RTX seems to be at least as effective as MMF and CYC pulses in inducing remission. Considering that patients treated with RTX had more negative renal prognostic factors, this drug should be considered a viable alternative for the treatment of active LN. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Moroni, G., Raffiotta, F., Trezzi, B., Giglio, E., Mezzina, N., Del Papa, N., et al. (2014). Rituximab vs mycophenolate and vs cyclophosphamide pulses for induction therapy of active lupus nephritis: A clinical observational study. RHEUMATOLOGY, 53(9), 1570-1577 [10.1093/rheumatology/ket462].

Rituximab vs mycophenolate and vs cyclophosphamide pulses for induction therapy of active lupus nephritis: A clinical observational study

Trezzi, B;SINICO, RENATO ALBERTO
Ultimo
2014

Abstract

Objective. We report the first comparison between rituximab (RTX) and either MMF or CYC pulses in the treatment of active LN. Methods. Fifty-four patients with active LN received three methylprednisolone pulses for 3 consecutive days followed by oral prednisone and RTX 1 g at days 3 and 18 (17 patients) or MMF 2-2.5 g/day (17 patients) or six CYC pulses (0.5 g every fortnight) (20 patients). At 4 months MMF, AZA or ciclosporin were associated to prednisone as a consolidation/maintenance therapy in all groups. The outcomes of the three groups were compared at 3 and 12 months. Results. Patients in the RTX group were older, had a longer duration of SLE and LN, had more renal flares, had higher activity and had higher chronicity indexes at renal biopsy than the other two groups. Four patients in each group had acute renal dysfunction and ∼50% had nephrotic syndrome. At 3 months, proteinuria was reduced by 50% in 58.8% of patients on RTX, in 64.7% on MMF and in 63.1% on CYC. At 12 months, complete remission was present in 70.6% of patients on RTX, in 52.9% on MMF, and in 65% on CYC. Partial remission was reached in 29.4% on RTX, 41.2% on MMF, and 25% on CYC. Conclusion. RTX seems to be at least as effective as MMF and CYC pulses in inducing remission. Considering that patients treated with RTX had more negative renal prognostic factors, this drug should be considered a viable alternative for the treatment of active LN. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
Articolo in rivista - Articolo scientifico
Cyclophosphamide pulse therapy; Lupus nephritis; Mycophenolate therapy; Rituximab therapy; Systemic lupus erythematosus; Administration, Oral; Adult; Antibodies, Monoclonal, Murine-Derived; Cyclophosphamide; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Lupus Nephritis; Male; Middle Aged; Mycophenolic Acid; Rituximab; Severity of Illness Index; Treatment Outcome; Young Adult; Rheumatology; Pharmacology (medical)
English
2014
53
9
1570
1577
ket462
none
Moroni, G., Raffiotta, F., Trezzi, B., Giglio, E., Mezzina, N., Del Papa, N., et al. (2014). Rituximab vs mycophenolate and vs cyclophosphamide pulses for induction therapy of active lupus nephritis: A clinical observational study. RHEUMATOLOGY, 53(9), 1570-1577 [10.1093/rheumatology/ket462].
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/139225
Citazioni
  • Scopus 65
  • ???jsp.display-item.citation.isi??? 54
Social impact