Rituximab Treatment in Lupus Nephritis Resistant to Conventional Therapy: A Single-Centre Experience

Treatment-resistant lupus nephritis (LN) is a challenging condition, often causing significant morbidity. While midterm outcomes of anti-CD20 therapies are well-studied, their long-term effects remain unclear.

To assess Rituximab's long-term efficacy and safety in patients with refractory LN.

The study, conducted retrospectively at a single centre between 2010-2022, included lupus nephritis patients who met the American College of Rheumatology's criteria for SLE. We evaluated 24-hour proteinuria, creatinine clearance, serum creatinine, and SLEDAI-2K, before and after rituximab treatment. The primary endpoints as a response to treatment were defined as the attainment of a prednisolone dose of 5mg and 24-hour proteinuria of 500mg. Additionally, we investigated any adverse effects of Rituximab.

Patients (34 females, 13 males; mean age 42.3 years; mean disease duration 10.4 years) received a median 3 of rituximab courses. Before treatment, median amount of proteinuria was 3050mg/day. Following the final course of rituximab, the median amount of proteinuria significantly decreased to 747mg/day (p<0.001). SLEDAI-2K score also reduced significantly, from 16.3±6.2 to 7.2±4.8 (p<0.001). The mean steroid dose in the final rituximab course was 7.5±5.8 mg/day (p<0.001), compared to the initial dose of 24.13±18.47mg/day. At primary endpoint, 53.1% of patients achieved a prednisolone dose of 5mg, 36.1% had a 24-hour proteinuria level of 500mg, and 25.5% met both criteria.

Rituximab significantly improved disease activity in lupus nephritis patients, reducing proteinuria, SLEDAI-2K scores, and allowing for steroid dose reduction. Given its efficacy and safety, rituximab may be a promising option for patients resistant to conventional therapy.