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Rituximab (Rtx) is a monoclonal anti-CD20 antibody used in renal diseases with glomerular involvement, which typically presents with proteinuria. The aim of this study was to evaluate the efficacy and safety of Rituximab in the treatment of glomerular diseases and the response to this treatment.
In retrospective observational study, we include record of 20 patients diagnosed with glomerulopathy who received Rituximab treatment 1 gram every 15 days, (a total of 2 grams). We recorded age, gender, a history of diabetes (DBT), arterial hypertension (HTA), renal biopsy diagnosis, non-responder to prior inmunosuppresive treatment-based glucocorticoids, mycophenolate (MMF), cyclophosphamide (CYC), or cyclosporine (CsA). We also recorded glomerular filtration rate, 24-hour proteinuria, albumin, cholesterol, and triglycerides at the time of Rituximab infusion, at 3 month and 6 months post-infusion. Additionally, adverse effects of Rituximab were recorded, genetic studies, and the need for renal replacement therapy (TRR) in the year following the treatment. We defined partial remission as a decrease of at least 50% in the proteinuria value and complete remission as a reduction of proteinuria to less than 500 mg/day, with stable renal function.
We included 20 patients with glomerulopathy from 2021-2023 treated with Rituximab. Patient’s characteristics were as follows: average age 43+17 years, 63% males, 5 % with Diabetes history and 16% with arterial hypertension. The distribution of the groups according to the renal biopsy result was: 36% membranous glomerulonephritis, 26% minimal changes, 15% focal and segmental glomerulosclerosis, 10% ANCA-associated vasculitis with PR3 and 10% membranoproliferative due to immune complexes. It was also determined that the previous treatment before Rituximab was resistant to them: 94% received corticoids, 5% MMF, 26% CYC and 63% CsA.
Laboratory values before the Rituximab infusion were glomerular filtration rate by CKD-EPI 62+33ml/min/1,73 m2, 24-hour proteinuria at the time of Rituximab was 6203+4859 mg/day, at 3 months 5255+3549 mg/days, at 6 months 6060+4789 mg/days. Albumin at the time of medication was 2,4+1 mg/dl, at 3 months 2,7+0,9 mg/dl and 6 months 2,8+0,8 mg/dl. Cholesterol levels were 282+104 mg/dl, 279+89 mg/dl, and 254+81 mg/dl respectively. The percentages of patients who achieved remission was 58%, distributed as follows, 37% complete remission and 21% partial remission. There were no differences in the response to the remission between the non-proliferative and proliferative glomerulopathy (pNS)
Only 5% of the patients presented any adverse reaction to Rituximab, and 15% received 1 gram booster dose 6 months after the beginning of the treatment. Additionally, 10% had genetic studies with negative results and 26% required TRR a year after Rituximab.
In this the population studied Rituximab was effective in achieving remission in more than half of the patients with glomerulopathies resistant to other immunosuppressants, with few adverse effects.