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Remission of refractory lupus nephritis with a protocol including rituximabDivision of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy
Division of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy, Dipartimento di Scienze Mediche, Universitàdel Piemonte Orientale ‘Amedeo Avogadro’, Novara, Italy
Division of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy, Dipartimento di Scienze Mediche, Universitàdel Piemonte Orientale ‘Amedeo Avogadro’, Novara, Italy, bartoli{at}med.unipmn.it Immunosuppression with corticosteroids and cyclophosphamide is the standard of care for lupus nephritis. We report a 19-year old woman with lupus nephritis and nephrotic syndrome who had not achieved complete remission after treatment with 15.7g cyclophosphamideand 13.7g prednisone.We planned a consolidation phase with: 1) cyclophosphamide 20mg/kg i.v. every 28 days for three cycles; 2) anti-CD20 chimeric monoclonal antibody (rituximab) 375mg/m2 i.v. weekly for four weeks; and 3) slow tapering of prednisone p.o., q.o.d., after a reinduction dose during rituximab administration. At the end of this phase the patient achieved complete remission. An indefinite maintenance treatment with methotrexate, cyclosporin and low-dose prednisone was then started. Twenty-four months later the patient remains in remission. In the immunosuppressive treatment of lupusnephritisthe insertionof a consolidationphasewith rituximab combinedwith cyclophosphamide achieves a therapeutically important and lasting deletion of the lymphocyte clone responsible for autoimmunity.
Key Words: immunosuppression • lupus nephritis • rituximab • systemic lupus erythematosus (SLE)
Lupus, Vol. 12, No. 10,
783-787 (2003) This article has been cited by other articles:
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