Journal Article

Beyond the LUNAR trial. Efficacy of rituximab in refractory lupus nephritis

Marc Weidenbusch, Christoph Römmele, Angelika Schröttle and Hans-Joachim Anders

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 28, issue 1, pages 106-111
Published in print January 2013 | ISSN: 0931-0509
Published online July 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfs285
Beyond the LUNAR trial. Efficacy of rituximab in refractory lupus nephritis

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Background

The treatment of lupus nephritis (LN) remains problematic because the current treatment regimen based on unspecific immunosuppressants such as steroids, cyclophosphamide and mycophenolate has significant side effects and is often inefficient. B-cell ablation with the chimeric anti-CD20 antibody rituximab (RTX) has been considered as an alternative treatment option but the randomized controlled LUNAR trial failed to show any additive effect of RTX beyond a steroid–mycophenolate mofetil (MMF) combination for LN type III/IV/V in incident patients. At present, no such trial is available for the use of RTX in refractory LN.

Methods

We analysed existing evidence on this topic by performing a systematic analysis of reports that document outcomes of RTX treatment for refractory LN.

Results

Out of 233 reports, we selected 26 for analysis, which described 300 patients with a mean follow-up of 60 weeks. The complete or partial response criteria were met by 87% of patients with LN class III, 76% with class IV and 67% with class V, respectively. Mixed classes responded in 76% of patients. RTX induced complete responses in 60% (type III), 45% (type IV), 40% (type V) and 24% (mixed types), respectively.

Conclusions

Our systematic review of existing evidence suggests that RTX effectively induces remission of LN in patients who have not achieved remission with standard therapies. Another randomized controlled trial should be conducted to test the efficacy of RTX in refractory LN.

Keywords: systemic lupus erythematosus; glomerulonephritis; B-cell ablation; proteinuria; anti-CD20; B-cells; lupus nephritis; MabThera; remission; response; therapy

Journal Article.  3130 words.  Illustrated.

Subjects: Nephrology

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