Table 1:
Rituximab for refractory lupus nephritis: Selected studies
| Reference | N | Refractory or relapsing lupus nephritis | Follow up (months) | Rituximab Dose Regimen | Response to rituximab |
|---|---|---|---|---|---|
| Gunnarsson et. al (38) | 7 | CYC resistant LN | 6 | 375 mg/m2/week × 4 | SLEDAI scores improved, decrease in the renal activity index- on repeat biopsy at 6 months |
| Goswami et.al (39) | 14 | Refractory or relapsing LN | 6 | Not specified | CR 71.4% PR 28.6% |
| Davies et. al (40) | 18 | All patients had severe, active disease and had failed conventional therapy including MMF and CYC | 6 | Two 1 g infusions two weeks apart. | CR 61.1% PR 11.1% |
| Melander et. al (13) | 20 | Eighteen patients (90%) had already received at least one conventional therapy including intravenous CYC in 15 patients, with a median cumulative dose of 6 g | 22 | 375 mg/m2/week × 4 | CR 35% PR 25% |
| Contis et.al (41) | 17 | All patients with refractory LN defined as resistant to standard treatment with CYC | 12 | 375 mg/m2/week × 4 (10 patients) or two infusions of 1 g at day 0 and day 15 (seven Patients). | CR or PR 53% |
| Jonsdottir et. al (42) | 25 | 23 patients refractory to conventional therapy including CYC and/or MMF | 12 | 375 mg/m2/week × 4 | CR 64% PR 24% |
| Lindholm et.al (43) | 17 | signs of active kidney inflammation despite ongoing treatment with CYC (n = 14) or MMF (n = 3) | 6–12 | 375 mg/m2/week × 4 | CR 12% PR 53% |
| Iwata et. al (44) | 63 with SLE, 36 with LN | All refractory to high-dose steroids and various conventional therapies including CYC (54%), MMF (16%), CNI (14%) | 12 | 500 mg twice at one-week intervals (days 1 and 8) in 22 patients; 500 mg at one-week intervals (days 1, 8, 15 and 22) in nine patients; 1000 mg infused at two-week intervals (days 1, 15) in seven patients; 1000 mg infused (days 1, 15, 168, 182) in 25 patients |
BILAG score improved in 83.3% UPCR decreased significantly |
| Iaccrino et.al (45) | 145 with SLE, 68 with LN | All had failure of at least one immunosuppressant | 12 | 118 with two infusions (1 g), two weeks apart; 27 with 375 mg/m2/week × 4, followed in 10 cases by two further doses, after 1 and 2 months | CR 30.9% PR 63.2% |
Abbreviations: CYC, cyclophosphamide; MMF, mycophenolate mofetil; CNI, calcineurin inhibitor, CR, complete response; PR, partial response; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index