Immunological remission in PLA2R-antibody–associated membranous nephropathy: cyclophosphamide versus rituximab

Logt, Anne-Els van de; Dahan, Karine; Rousseau, Alexandra; Molen, Renate van der; Dębiec, Hanna; Ronco, Pierre; Wetzels, Jack F.M.

doi:10.1016/j.kint.2017.12.019

Cited by 62 publications

(53 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We previously showed that RTX was less efficacious at 2 weekly doses of 375 mg/m 2 than was cyclophosphamide/steroid combination therapy in inducing immunological remission in patients with high levels of PLA2R Abs. 28 In addition, we previously reported that a second course of RTX had a dramatic effect on PLA2R Abs titers, with all but 1 patient reaching complete immunological remission and all retreated patients showing clinical remission. 29 The retreatment regimen was stimulated by the GEMRITUX trial where PLA2R Abs levels were markedly decreased as early as 3 months after RTX but not followed by further decrease at 6 months, suggesting an early loss of efficacy of the monoclonal Ab.…”

Section: Clinical and Immunological Outcomesmentioning

confidence: 90%

Rituximab in Patients With Phospholipase A2 Receptor–Associated Membranous Nephropathy and Severe CKD

Hanset

Estève

Plaisier

et al. 2020

Kidney International Reports

Self Cite

View full text Add to dashboard Cite

Introduction: Patients with phospholipase A2 receptor (PLA2R)-associated membranous nephropathy and stage 4 or 5 chronic kidney disease are at high risk of end-stage kidney disease. In recent years, rituximab (RTX) emerged as a safe and efficient treatment for patients with PLA2R-associated membranous nephropathy. Whether its use is also appropriate in patients with an estimated glomerular filtration rate <30 ml/min per 1.73 m 2 has not been investigated. Methods: We retrospectively reviewed characteristics and outcome of 13 patients with PLA2R-associated membranous nephropathy and stage 4 or 5 chronic kidney disease who received a total of 14 consecutive RTX treatments from January 2012 to March 2018. The treatment regimen consisted of either 2 weekly infusions of 375 mg/m 2 or 2 RTX infusions of 1 g/d two weeks apart. When needed, the regimen was repeated to achieve immunological remission. Results: The mean estimated glomerular filtration rate, serum albumin level, and urinary protein level at the first RTX infusion were 18 AE 7 ml/min per 1.73 m 2 , 25.2 AE 5.4 g/l, and 13.2 AE 7.5 g/d, respectively, with all patients being tested positive for serum PLA2R antibodies. Ten treatment courses led to an increase in estimated glomerular filtration rate and remission of nephrotic syndrome after a median follow-up of 40.8 months (interquartile range, 14.8-46.8). Conversely, 4 RTX treatments were unsuccessful, with patients requiring chronic hemodialysis within 1 year. The urinary albumin-to-protein ratio before treatment was predictive of renal response. Immunological remission occurred after 11 treatment courses and was associated with clinical response in 10 of 11 patients. Three patients experienced severe adverse events. Conclusion: RTX seems effective and reasonably safe in PLA2R-associated membranous nephropathy with stage 4 or 5 chronic kidney disease. Immunological remission is associated with a good clinical outcome.

show abstract

Section: Clinical and Immunological Outcomesmentioning

confidence: 90%

Rituximab in Patients With Phospholipase A2 Receptor–Associated Membranous Nephropathy and Severe CKD

Hanset

Estève

Plaisier

et al. 2020

Kidney International Reports

Self Cite

View full text Add to dashboard Cite

show abstract

“…A 2018 published comparison between cyclophosphamide and rituximab considered immunological remission [8]. The disappearance of antibody levels in cyclophosphamide-treated patients versus rituximab-treated patients who were positive for the antibody at the start of treatment was measured after 6 months.…”

Section: Glomerulonephritis: Jack Wetzels (The Netherlands)mentioning

confidence: 99%

Nephro Update Europe 2018

Kesel¹

2019

Kidney Dis

View full text Add to dashboard Cite

“…A recent study should be mentioned here. Van de Logt et al [8] compared immunological remission rates in cohorts of patients treated with either rituximab or cyclophosphamide. There was no difference in immunological remission rate between these 2 treatments in patients with low or moderate antibody levels.…”

Section: Quantitative Analysis Of Pla2rab: An Ending or A New Beginning?mentioning

confidence: 99%

Antibodies Against M-Type Phospholipase Receptor and Prediction of Outcome in Membranous Nephropathy: We are Not There Yet

Wetzels

2018

Am J Nephrol

View full text Add to dashboard Cite

Immunological remission in PLA2R-antibody–associated membranous nephropathy: cyclophosphamide versus rituximab

Cited by 62 publications

References 3 publications

Rituximab in Patients With Phospholipase A2 Receptor–Associated Membranous Nephropathy and Severe CKD

Rituximab in Patients With Phospholipase A2 Receptor–Associated Membranous Nephropathy and Severe CKD

Nephro Update Europe 2018

Antibodies Against M-Type Phospholipase Receptor and Prediction of Outcome in Membranous Nephropathy: We are Not There Yet

Contact Info

Product

Resources

About