Sans-Pola Carla, Agustí Antònia, Bosch Josep Àngel, Agraz Irene, Alerany Carmen, Danés Immaculada
Department of Clinical Pharmacology, Vall d'Hebron Hospital Universitari, 08035 Barcelona, Spain.
Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
J Clin Med. 2021 Oct 26;10(21):4941. doi: 10.3390/jcm10214941.
Off-label use of rituximab is commonly requested for patients with resistant nephropathies. The outcomes and tolerability of rituximab in adult patients with nephropathy treated at our hospital (from 2013 to 2018) were described. Data were retrieved from electronic medical records. Response was classified as complete remission (CR), partial remission (PR), or no response (NR) according to the KDIGO criteria. A total of 89 requests were received for 61 patients. Median age was 58 years (45.9% female). Idiopathic membranous nephropathy (MN) ( = 30) was the most frequent indication, followed by minimal change disease (MCD) ( = 15) and secondary membranoproliferative glomerulonephritis (MPGN) ( = 12). Three patients with focal segmental glomerulosclerosis (FSGS) were included. After most treatment cycles in MN, a CR or PR was observed; median proteinuria levels significantly decreased for these patients (6000 mg/24h (IQR 3584-10,300) vs. 1468.8 (IQR 500-4604.25), < 0.01). In MPGN, no response was documented after 46.7% of rituximab cycles. A CR or PR was described with the majority of rituximab cycles in MCD, with a significant decrease in proteinuria (6000 mg/24 h (IQR 4007-11,426) vs. 196.8 (IQR 100-1300), = 0.013). No cycles produced a response in FSGS. Mean CD19+ B-cell decreased in all types of nephropathy (10.44% vs. 0.29%, < 0.0001). Eleven patients presented infusion-related reactions, and 17 presented infectious complications. The majority of patients with MN and MCD had complete or partial responses; however, neither MPGN nor FSGS had encouraging results.
利妥昔单抗的超说明书用药在难治性肾病患者中很常见。本文描述了我院（2013年至2018年）治疗的成年肾病患者使用利妥昔单抗的疗效和耐受性。数据从电子病历中获取。根据KDIGO标准，反应分为完全缓解（CR）、部分缓解（PR）或无反应（NR）。共收到61例患者的89次用药申请。中位年龄为58岁（女性占45.9%）。特发性膜性肾病（MN）（n = 30）是最常见的适应证，其次是微小病变病（MCD）（n = 15）和继发性膜增生性肾小球肾炎（MPGN）（n = 12）。纳入了3例局灶节段性肾小球硬化（FSGS）患者。在MN的大多数治疗周期后，观察到CR或PR；这些患者的蛋白尿水平中位数显著下降（6000 mg/24h（IQR 3584 - 10300） vs. 1468.8（IQR 500 - 4604.25），P < 0.01）。在MPGN中，46.7%的利妥昔单抗治疗周期后未记录到反应。在MCD的大多数利妥昔单抗治疗周期中描述有CR或PR，蛋白尿显著下降（6000 mg/24 h（IQR 4007 - 11426） vs. 196.8（IQR 100 - 1300），P = 0.013）。FSGS中没有治疗周期产生反应。所有类型肾病中平均CD19 + B细胞均减少（10.44% vs. 0.29%，P < 0.0001）。11例患者出现输液相关反应，17例出现感染并发症。大多数MN和MCD患者有完全或部分反应；然而，MPGN和FSGS均未取得令人鼓舞的结果。
