J Rheum Dis.  2022 Jan;29(1):22-32. 10.4078/jrd.2022.29.1.22.

Initial Preserved Renal Function as a Predictor of Favorable Renal Response to Rituximab in Refractory or Relapsing Lupus Nephritis: A Single-center Cohort Study in Korea

• Choi SJ
• Ahn SM
• Oh JS
• Hong S
• Lee CK
• Yoo B
• Kim YG

• KMID: 2523456
• DOI: http://doi.org/10.4078/jrd.2022.29.1.22

Abstract

Objective
Previous studies investigating the beneficial effect of rituximab on lupus nephritis (LN) reported controversial results. There have been few reports of renal response to rituximab according to renal function. We investigated the efficacy of rituximab in refractory/relapsing LN and the role of renal function as a predictor of renal response.
Methods
From 2016 to 2019, we retrospectively reviewed 22 patients with refractory/relapsing LN receiving rituximab. Renal responses (complete and partial) at 6 and 12 months were compared between normal (glomerular filtration rate [GFR]≥90 mL/min/1.73 m² , n=11) and decreased (GFR＜90 mL/min/1.73 m² , n=11) GFR groups. Multivariate Cox regression analysis was used to assess predictors of renal response.
Results
At baseline, the decreased GFR group had a higher urine proteinuria to creatinine ratio (p=0.008) and proportion of refractory LN (p=0.010) and previous cyclophosphamide therapy (p=0.035) than the normal GFR group. The overall renal response rate was 45.5% (10 patients) at 6 months and 54.5% (12 patients) at 12 months. Renal response rates were higher in the normal GFR group (81.8% and 90.9% at 6 and 12 months, respectively) than in the decreased GFR group (9.1% and 18.2% at 6 and 12 months, respectively; p＜0.001). Normal GFR and anti-La were associated with renal response to rituximab, with hazard ratios of 9.256 (p=0.008) and 5.478 (p=0.041), respectively.
Conclusion
Rituximab is an effective therapy for refractory/relapsing LN, particularly in patients with preserved renal function.

Keyword

Lupus nephritis; Systemic lupus erythematosus; Kidney; Rituximab; Glomerular filtration rate

Figure

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  Figure 1 Kaplan–Meier curves for (A) the renal response rate in all patients and (B) renal response rates in normal and decreased glomerular filtration rate groups. Renal response was defined as the achievement of complete or partial renal response. GFR: glomerular filtration rate.

• 

  Figure 2 Changes in clinical parameters in normal and decreased glomerular filtration rate groups. (A) Urine protein to creatinine ratio (UPCR). (B) Glomerular filtration rate (GFR). (C) Serum albumin. (D) Anti-dsDNA titer. (E) C3. (F) C4. Data are expressed as median (interquartile range). Wilcoxon signed-rank test was used to assess the changes in parameters from baseline within each group (*p<0.05, **p<0.01).

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