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Rituximab use as induction therapy for lupus nephritis: a systematic review
Liya Stolyar1, Robert G Lahita2, Richard S Panush1
1Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA.
Rituximab (RTX) shows potential for lupus nephritis (LN) treatment, with varying effectiveness across ethnic groups. Further randomized controlled trials are needed to establish its role and optimal use in diverse patient populations.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Lupus nephritis (LN) requires effective and safe treatments.
- Rituximab (RTX) is used for rheumatoid arthritis and vasculitis, but its role in LN is not definitively established.
- Existing trials of RTX for LN have yielded inconclusive results.
Purpose of the Study:
- To systematically review and analyze the effectiveness of Rituximab (RTX) in treating lupus nephritis (LN).
- To assess complete renal response (CRR) and partial renal response (PRR) in LN patients treated with RTX.
- To identify factors influencing RTX efficacy, including patient ethnicity and disease characteristics.
Main Methods:
- A systematic review of 31 studies involving RTX for class I-VI lupus nephritis (LN).
- Exclusion of studies focused solely on pediatric patients.
- Assessment of complete renal response (CRR) and partial renal response (PRR) based on serum creatinine, proteinuria, and urinary sediment.
Main Results:
- One randomized controlled trial (RCT) indicated RTX plus cyclophosphamide (CYC) was superior to CYC alone for CRR (64% vs. 21%).
- Studies using RTX monotherapy or in combination with CYC or mycophenolate mofetil (MMF) showed a 66% CRR or PRR.
- Complete renal response (CRR) rates varied significantly by ethnicity: 77% for Caucasian, 38% for East Asian, and 28% for Hispanic patients.
Conclusions:
- Rituximab (RTX) may benefit certain lupus nephritis (LN) patients, but evidence is limited by non-randomized, heterogeneous studies.
- RTX monotherapy might be insufficient for B-cell depletion in LN.
- Efficacy of RTX may differ across ethnic backgrounds, necessitating cautious interpretation and further research, including prospective RCTs with diverse populations and treatment combinations.
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