S NAYAR1, B PAWAR1, S THOMAS1, D FERNANDES1, PGEORGE1, SBRADY1, C SAJIV1
1Alice Springs Hospital, Alice Springs, Australia
Background: Rituximab, an anti-CD20 B cell depleting monoclonal antibody, is prescribed off-label for Systemic Lupus Erythematosus (SLE) for various indications.
Aim: To analyse the outcome of rituximab treated SLE along with standard immunosuppression.
Method: Performed a retrospective analysis of rituximab use at Alice Springs Hospital.
Results: Five female patients received rituximab. First patient, a Caucasian with no lupus nephritis, received rituximab for refractory thrombocytopenia. Her disease activity has been under control for 30 months with normal renal function and stable platelets without any adverse events. Other four patients were Indigenous with biopsy-proven active International Society of Nephrology/Renal Pathology Society (ISN/RPS) class IV/V lupus nephritis (LN). In Class IV/V LN group, two patients received rituximab due to nonresponse to standard induction therapy. One patient had progressive renal failure due to non adherence to treatment and lacked adequate response and became dialysis depended in 3 months with no adverse events. Second patient did not achieve complete or partial remission but had stable renal function 18 months post rituximab treatment with 2 episodes of soft tissue infections and one episode of pneumonia. In Class IV LN group, one patient received rituximab twice for nonresponse to induction with cyclophosphamide and for an episode of relapse, first dose complicated with infusion reaction and subsequent dose was tolerated after desensitisation, had partial response and was dialysis free for 8 years without any further adverse events. Second patient received rituximab along with mycophenolate and methyl prednisolone and follow up for 7 weeks had transient neutropenia with normal renal function.
Conclusion: Addition of rituximab has shown good response in all patients except one with no significant increase in adverse events.
Consultant Renal Physician working at Alice Springs Hospital, a major interventional nephrology centre in Central Australia for the last 3 years, actively involved in indigenous renal health and research.