Rituximab is an effective treatment for lupus nephritis and allows a reduction in maintenance steroids

Pepper, Ruth J.; Griffith, Megan; Kirwan, Chris; Levy, Jeremy; Taube, David; Pusey, Charles D.; Lightstone, Liz; Cairns, Tom

doi:10.1093/ndt/gfp336

Cited by 142 publications

(108 citation statements)

References 32 publications

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“…Tables 1 and 2 show a summary of included studies. We found 2 RCTs (Furie et al, 2009;Merrill et al, 2011) and 19 observational studies (Leandro et al, 2002;Leandro et al, 2005;Vigna-Perez et al, 2006;Gunnarsson et al, 2007;Tokunaga et al, 2007;Sutter et al, 2008;Tamimoto et al, 2008;Melander et al, 2009;Pepper et al, 2009;Catapano et al, 2010;Lateef et al, 2010;Ramos-Casals et al, 2010;Terrier et al, 2010;Pinto et al, 2011;Roccatello, 2011;Tony et al, 2011;Turner-Stokes et al, 2011;Vital et al, 2011;Arce-Salinas et al, 2012).…”

Section: Resultsmentioning

confidence: 76%

“…Dose of rituximab The dosing of rituximab in SLE patients varied between studies; some followed the rheumatoid arthritis guidelines ((0.5-1.0 g)×2 infusions) (Leandro et al, 2002;Vigna-Perez et al, 2006;Pepper et al, 2009;Terrier et al, 2010;Pinto et al, 2011), and some followed a lymphoma schedule (375 mg/m 2 × 4 weeks) (Gunnarsson et al, 2007;Tokunaga et al, 2007;Sutter et al, 2008;Tamimoto et al, 2008;Melander et al, 2009;Catapano et al, 2010;Lateef et al, 2010;Ramos-Casals et al, 2010;Terrier et al, 2010;Roccatello et al, 2011;Vital et al, 2011;Arce-Salinas et al, 2012). In our review, except for the German Registry of Autoimmune Diseases (GRAID) studies in Germany, 268 (50.9%) cases received a rituximab (0.5-1.0 g)×2 infusions, 211 (40.1%) received a rituximab infusion of 375 mg/m 2 × 4 weeks, and 46 (8.7%) cases received a dose of rituximab ≤375 mg/m 2 ×2 weeks.…”

Section: Characteristics Of the Patients In 19 Observational Studiesmentioning

confidence: 99%

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Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

Lan

Han

Chen

2012

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To review the efficacy and safety of rituximab therapy for systemic lupus erythematosus (SLE). Methods: We searched for randomized controlled trails and observational studies that evaluated the effect of rituximab based on the systemic lupus erythematosus disease activity index (SLEDAI), British Isles lupus assessment group index (BILAG), urine protein levels, and the prednisolone dose, and had adequate data to calculate the mean, standard deviation (SD), and 95% confidence intervals, and to systematically review and meta-analyze observational studies with fixed effects model or random effects model. Results: We included 2 randomized controlled studies and 19 observational clinical studies. We summarized the data from the 19 observational studies, analyzed the heterogeneity of the literature, and then used fixed effect model or random effect model for statistical analysis. The SLEDAI, BILAG, and urine protein levels and the prednisolone dosage were decreased after rituximab treatment, and the decreases in the BILAG, urine protein levels, and the prednisolone dose were found to be significant (P<0.05), when compared with baseline level. Rituximab's adverse effects generally could be controlled with an effective dosing regimen. Conclusions: Although there are still controversies about rituximab's treatment on SLE, but our study had showed that rituximab had favorable effects on refractory lupus. The long-term efficacy and safety of rituximab require further study.

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Section: Resultsmentioning

confidence: 76%

Section: Characteristics Of the Patients In 19 Observational Studiesmentioning

confidence: 99%

Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

Lan

Han

Chen

2012

J. Zhejiang Univ. Sci. B

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“…There are few clinical trials examining their role as first line induction or maintenance therapy. One exception to this has been the successful use of rituximab as first line induction therapy followed by maintenance mycophenolate mofetil in a cohort of eighteen patients with proliferative nephritis (Pepper et al, 2009). Although so far many biologics e.g.…”

Section: Resultsmentioning

confidence: 99%

“…Pepper et al reported the use of rituximab as induction therapy followed by maintenance mycophenolate mofetil in a cohort of eighteen patients with proliferative lupus nephritis. A significant decrease in proteinuria from a mean protein: creatinine ratio (PCR) of 325 mg/mmol at presentation to 132 mg/mmol at 1 year (p = 0.004) was demonstrated and this combination of sequential therapy allowed a reduction or total withdrawal of maintenance corticosteroids (Pepper et al, 2009). The French Autoimmune and Rituximab (AIR) registry reviewed one hundred thirty-six patients who received this treatment for SLE.…”

Section: Rituximab (Anti-cd20)mentioning

confidence: 96%

New Therapeutic Strategies in Lupus Nephritis

Jordan¹,

Karim²

2012

Systemic Lupus Erythematosus

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“…Among other small sample open clinical trials, encouraging results of Rituximab, such as steroid-sparing effects and histological improvement in treating LN, were reported [163][164][165]. The negative results of EXPLORER and LUNAR trials may mainly due to the imperfect study design such as the enrollment criteria of baseline severity, evaluation tools and endpoints settings, instead of inefficiency.…”

Section: Cd20-targeted Therapymentioning

confidence: 99%

B cells biology in systemic lupus erythematosus—from bench to bedside

Zhang

2015

Sci. China Life Sci.

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Systemic lupus erythematosus (SLE) is a debilitating autoimmune disease that can involve multi-organs. B cells play a central role in the immunopathogenesis via antibody-dependent and antibody-independent ways. Excessive autoantibodies production, hyperresponsiveness and prolonged survival of autoreactive B cells are characteristics of SLE. In this article, mechanisms of self-tolerance loss of B cells and promising B cell-targeting therapies in lupus are reviewed and discussed. Systemic lupus erythematosus (SLE), the paradigm of autoimmune disease with the underlying mechanisms involving multiple immunological abnormalities, is a severely debilitating disease with multi-organ involvement and diverse autoantibodies spectrum [1]. Among the multiple elements in the pathogenesis, B cells play a central role in SLE through antibody dependent and independent manners [2]. Presence of pathogenic autoantibodies is not only the hallmark of SLE and the clue for diagnosis, but also associated with characteristic pathological injury and specific clinical manifestations [3][4][5]. In addition, the pathogenic role of B cells is also attributed to its antibody independent functions, including but not limited to antigen presentation, T cell crosstalk, dendritic cells (DCs) recruitment, pro-inflammatory cytokine secretion. Why and how auto-reactive B cells in lupus lose self-tolerance, escape from central and peripheral checkpoints, become over-activated and spontaneously produce autoantibodies, are always the focus of clinical and basic research. Therefore, it is important to summarize our current knowledge about the underlying mechanisms of self-tolerance breakdown and pathogenic functioning pathways of B cells in SLE. So we review here about B cell biology in SLE, including its differentiation and selection, functioning and signaling, surviving and apoptosis, and the resulting potential therapeutic targets both in mice and human lupus.

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Rituximab is an effective treatment for lupus nephritis and allows a reduction in maintenance steroids

Abstract: This data demonstrates the efficacy of a rituximab and MMF based regime in the treatment of lupus nephritis, allowing a reduction or total withdrawal of corticosteroids.

Cited by 142 publications

References 32 publications

Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

New Therapeutic Strategies in Lupus Nephritis

B cells biology in systemic lupus erythematosus—from bench to bedside

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