Rituximab for treatment of severe lupus nephritis

Background

Systemic lupus erythematosus (SLE) is a challenging disease to diagnose and manage. Treatment of lupus nephritis in resistant cases is still a matter of debate.

Aim

To investigate the effectiveness of rituximab (Rx) in treatment resistant cases of lupus nephritis.

Materials and methods

Five female patients with a median age of 14 years (range: 12–16 years) with class IV (3/5) and class II (2/5) lupus nephritis were treated with rituximab, steroids and plasmapheresis. Rituximab was given with a dose of 375 mg/m2/week for 4 weeks. Two patients had severe thrombocytopenia, while one of them had developed macrophage activating syndrome. All of them had renal failure with high serum creatinine. ANA and anti ds DNA levels were found to be high in 4 patients with low levels of compleman 3.

Results

Thrombocytopenia was completely resolved at the end of 4 weeks in both patients while only one patient had complete remission of the SLE. Partial remission was observed in two patients and 2 patients did not respond at all.

Conclusion

Rituximab could be effective in treatment of patients with severe, treatment resistant lupus nephritis.