Successful Outcome of a Corticodependent Henoch-Schönlein Purpura Adult with Rituximab

Sala, Taylor Pindi; Michot, Jean‐Marie; Snanoudj, Renaud; Dollat, Marion; Estève, Emmanuel; Marie, Bernadette; Taoufik, Yacine; Delfraissy, Jean‐François; Lazure, Thierry; Lambotte, Olivier

doi:10.1155/2014/619218

Cited by 28 publications

(4 citation statements)

References 18 publications

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“…Cases 1–3 had low-grade albuminuria (<250 mg/day), in one of these even decreasing during pregnancy when ACEi had to be stopped. Our positive results are in line with earlier reports on RTX therapy in IgAV and in recurrent IgAN after renal transplantation [ 10 – 12 , 14 , 18 , 19 ]. However, Sugiura et al [ 13 ] did not find any proteinuria reduction 6 months after single-dose RTX in 5 non-nephrotic IgAN patients.…”

Section: Discussionsupporting

confidence: 93%

“…Recently the efficacy of OFAB was demonstrated in five children with nephrotic syndrome resistant to conventional therapy and RTX [ 9 ]. A few case reports have been published on the positive treatment effects of RTX in IgAVN but there is no information on the use of OFAB in this disease [ 10 – 12 ]. An earlier prospective study of single-dose RTX treatment on top of corticosteroids (CSs) in five patients with non-nephrotic IgAN showed no reduction of proteinuria after 6 months.…”

Section: Introductionmentioning

confidence: 99%

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B cell–depleting therapy with rituximab or ofatumumab in immunoglobulin A nephropathy or vasculitis with nephritis

et al. 2016

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BackgroundApproximately 30% of adult patients with immunoglobulin A (IgA) nephropathy (IgAN) or IgA vasculitis with nephritis (IgAVN) develop end-stage renal disease during long-term follow-up. In particular, patients with nephritic–nephrotic syndrome have an increased risk of rapid progression. Conventional immunosuppressive therapy with corticosteroids (CSs) may be insufficient for disease control and is associated with a number of side effects. Rituximab (RTX) has been shown to be well tolerated and effective in a range of glomerular diseases, but there is little information on its therapeutic potential in IgAN. The humanized anti-CD20 monoclonal antibody ofatumumab (OFAB) may be an alternative drug for patients intolerant or unresponsive to RTX, but so far there is no report on its use in IgAVN or IgAN.MethodsWe describe clinical outcomes after 17–22 months in four adult patients with biopsy-confirmed IgAVN or IgAN treated with RTX or OFAB as well as CS soon after diagnosis. All presented with nephritic–nephrotic syndrome and one had crescentic IgAN. Rebiopsy was performed in two cases.ResultsRTX and OFAB were well tolerated. Albuminuria was <250 mg/day in three patients at last evaluation and two regained normal renal function. In all cases, renal function improved after therapy. In one patient with severe IgA vasculitis, rebiopsy showed disappearance of subendothelial but not mesangial immune complexes. In the case with crescentic IgAN, rebiopsy after 9 months showed no active necrotic lesions.ConclusionsB cell–depleting therapy may be an alternative treatment for patients with IgAN or IgAVN and nephritic–nephrotic syndrome. A possible CS-sparing effect should be further evaluated in randomized controlled clinical trials.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

B cell–depleting therapy with rituximab or ofatumumab in immunoglobulin A nephropathy or vasculitis with nephritis

et al. 2016

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“…Improvements of renal function are in line with earlier results on RTX therapy in nephropathies and in recurrent IgAN (13)(14)(15)(16)(17)(18). However, Sugiura et al (19) did not find any proteinuria reduction after singledose rituximab in five non-nephrotic IgAN patients.…”

Section: Rituximab For Improvement Of Renal Function In Igansupporting

confidence: 67%

Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts

Tamadon¹,

Moghimi²,

Rezaei³

2017

J Nephropathol

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Implication for health policy/practice/research/medical education:Several recently randomized clinical trials underline the substantial risk of side effects and the lack of proven efficacy with all kinds of immunosuppressive treatment including rituximab. In concordance, other studies observed a reduction of hematuria after RTX therapy. Please cite this paper as: Tamadon MR, Moghimi J, Rezaei H. Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts.

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“…Currently, glucocorticoids and immunosuppressants remain the mainstay for managing refractory IgAVN. However, recent research has focused on exploring biological agents such as monoclonal antibody rituximab for treating IgAVN [33][34][35][36]. Rituximab primarily targets CD20 on B lymphocyte, and its mechanism in the treatment of IgAV remains unknown.…”

Section: Plos Onementioning

confidence: 99%

DNase I targeted degradation of neutrophil extracellular traps to reduce the damage on IgAV rat

Chen,

Tu,

Tang

et al. 2023

PLoS ONE

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Background In the past two years, studies have found a significant increase in neutrophil extracellular traps (NETs) in patients with IgA vasculitis (IgAV), which is correlated with the severity of the disease. NETs have been reported as an intervention target in inflammatory and autoimmune diseases. This study aimed to investigate the effect of targeted degradation of NETs using DNase I in IgAV rat model. Methods Twenty-four Sprague-Dawley rats were randomly divided into three groups: the IgAV model group, the DNase I intervention group and the normal control group, with an average of 8 rats in each group. The model group was established by using Indian ink, ovalbumin, and Freund’s complete adjuvant. In the intervention group, DNase I was injected through tail vein 3 days before the end of established model. The circulating cell free-DNA (cf-DNA) and myeloperoxidase-DNA (MPO-DNA) were analyzed. The presence of NETs in the kidney, gastric antrum and descending duodenum were detected using multiple fluorescences immunohistochemistry and Western blots. Morphological changes of the tissues were observed. Results After the intervention of DNase I, there was a significant reduction in cf-DNA and MPO-DNA levels in the intervention group compared to the IgAV model group (all P<0.001). The presence of NETs in renal, gastric, and duodenal tissues of the intervention group exhibited a significant decrease compared to the IgAV model group (P < 0.01). Moreover, the intervention group demonstrated significantly lower levels of renal MPO and citrullinated histone H3 (citH3) protein expression when compared to the IgAV model group (all P < 0.05). The HE staining results of intervention group demonstrated a significant reduction in congestion within glomerular and interstitial capillaries. Moreover, there was a notable improvement in gastric and intestinal mucosa necrosis, congestion and bleeding. Additionally, there was a substantial decrease in inflammatory cells infiltration. Conclusion The degradation of NETs can be targeted by DNase I to mitigate tissue damage in IgAV rat models. Targeted regulation of NETs holds potential as a therapeutic approach for IgAV.

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Successful Outcome of a Corticodependent Henoch-Schönlein Purpura Adult with Rituximab

Cited by 28 publications

References 18 publications

B cell–depleting therapy with rituximab or ofatumumab in immunoglobulin A nephropathy or vasculitis with nephritis

B cell–depleting therapy with rituximab or ofatumumab in immunoglobulin A nephropathy or vasculitis with nephritis

Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts

DNase I targeted degradation of neutrophil extracellular traps to reduce the damage on IgAV rat

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