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2017 ; 10
(1
): 20-26
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B cell-depleting therapy with rituximab or ofatumumab in immunoglobulin A
nephropathy or vasculitis with nephritis
#MMPMID28638602
Lundberg S
; Westergren E
; Smolander J
; Bruchfeld A
Clin Kidney J
2017[Feb]; 10
(1
): 20-26
PMID28638602
show ga
BACKGROUND: Approximately 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. METHODS: We 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. RESULTS: RTX 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. CONCLUSIONS: B 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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