Combination therapy of rituximab and mycophenolate mofetil in childhood lupus nephritis

Hogan, Julien; Godron, A.; Baudouin, Véronique; Kwon, Thérèsa; Harambat, Jérôme; Deschênes, Georges; Niel, Olivier

doi:10.1007/s00467-017-3767-4

Cited by 21 publications

(14 citation statements)

References 23 publications

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“…Among the 940 publications identified, 24 studies met the inclusion criteria, with 1912,15–32 retrospective or prospective case series and five comparative studies 13,33–36…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen case series trials12,15–32 in patients with LN met our inclusion criteria. All studies used renal values as criteria to assess clinical outcome and define CR and TR.…”

Section: Resultsmentioning

confidence: 99%

“…Proteinuria was used to evaluate renal injury in five studies 19,21,22,27,32. RTX treatment decreased proteinuria (mean difference =−2.79, 95% CI: −3.95 to −1.62, P <0.01; Figure 3).…”

Section: Resultsmentioning

confidence: 99%

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<p>Clinical efficacy and safety of rituximab in lupus nephritis</p>

Zhong¹,

Li²,

Zhong

et al. 2019

DDDT

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BackgroundLong-term treatment programs with low toxicity represent a therapeutic challenge in lupus nephritis (LN). Although a therapeutic benefit of rituximab (RTX) has been reported in LN patients who have failed conventional treatment, the results are controversial. We aimed to assess the clinical efficacy and safety of RTX as a new immunosuppressive medicine in the treatment of LN with a meta-analysis.MethodsBased on predetermined criteria, PubMed, Embase, and Cochrane Library were used to identify the eligible studies. Cochrane Review Manager version 5.3 was applied to pool the data extracted from individual investigations and provide summary effect estimates.ResultsTwenty-four studies with 940 patients were analyzed. In case series trials with specific LN assessment, the complete remission (CR) rate at 12 months was 35.9% (95% CI: 24.2%–49.5%), and total remission (TR: CR plus partial remission) was 73.4% (95% CI: 66.0%–79.7%). In controlled trials, RTX was associated with a higher probability of TR (OR =2.02, 95% CI: 1.23–3.32, P<0.01). The CR in the RTX group was higher than that in the control group, although there was no significant difference between the two groups (OR =1.98, 95% CI: 0.90–4.39, P>0.05). Additionally, RTX treatment significantly decreased proteinuria (mean difference: −2.79, 95% CI: −3.95 to −1.62, P<0.01) as well as the renal activity index in patients with LN (mean difference: −3.46, 95% CI: −4.43 to −2.50, P<0.01). In controlled trials, the relative risks of the adverse events of infection and infusion reaction were not notably different between the two groups.ConclusionRTX is a promising therapy for the treatment of LN due to significant clinical efficacy and a favorable safety profile. In future studies, larger study populations and longer-term time points may identify additional important patient-centered outcomes.

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“…Among the 940 publications identified, 24 studies met the inclusion criteria, with 1912,15–32 retrospective or prospective case series and five comparative studies 13,33–36…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen case series trials12,15–32 in patients with LN met our inclusion criteria. All studies used renal values as criteria to assess clinical outcome and define CR and TR.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

<p>Clinical efficacy and safety of rituximab in lupus nephritis</p>

Zhong¹,

Li²,

Zhong

et al. 2019

DDDT

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“…Although, evidence is limited, combination of RTX and MMF or CYC might provide efficacious therapeutic effect for refractory cases of SLE including nephritis. However, it was associated with a high rate of infection [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no available cure for SLE presently, several drugs are useful in controlling the disease and contributed to a favorable outcome. Children with lupus nephritis, especially diffuse proliferative and membranous glomerulonephritis, may necessitate potent immunosuppressive medications such as cyclophosphamide (CYC) or mycophenolate mofetil (MMF) and occasionally rituximab (RTX) [5,6]. However, one third of such patients might either have frequent disease flares or be resistant to the treatment with disease progression [7,8].…”

Section: Introductionmentioning

confidence: 99%

Combination of tacrolimus and mycophenolate mofetil in persistent proteinuria due to refractory childhood lupus nephritis

Almutairi

Alkathiri

Al‐Mayouf

2018

International Journal of Pediatrics and Adolescent Medicine

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BackgroundChildren with lupus nephritis particularly, diffuse proliferative and membranous glomerulonephritis, may necessitate potent immunosuppressive medications and occasionally combined therapy.ObjectiveTo report the beneficial effects of tacrolimus (TAC) in children with refractory lupus nephritis from a single tertiary pediatric rheumatology clinic.MethodsThis is a retrospective case series of children with refractory lupus nephritis treated with TAC after failure of aggressive immunosuppressive treatment. All patients were evaluated at the time of initiation of TAC and at last follow-up visit by assessing the following response parameters: cSLE Disease Activity Index (SLEDAI), urine protein/creatinine ratio, urine sediments, serum albumin, complement (C3 and C4), anti-double-stranded DNA (dsDNA) antibody levels, and renal function assessed by glomerular filtration rate (eGFR).ResultsThree children (two girls and one boy) with lupus nephritis and persistent nephrotic-range proteinuria failed prednisone treatment as well as sequential treatment of cyclophosphamide, mycophenolate mofetil (MMF), and rituximab. When TAC was administered along with MMF and prednisone, all patients showed improvement in response parameters, namely, SLEDAI, serum albumin, and proteinuria, and prednisone doses were significantly weaned off and discontinued in two patients. However, eGFR remained stable during the treatment period. TAC was well tolerated, and no adverse effects were observed.ConclusionTAC combined with MMF can be considered as an alternative therapeutic option for children with refractory lupus nephritis particularly those with persistent nephrotic-range proteinuria.

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