Use of rituximab in the treatment of lupus nephritis in compares to cyclophosphamide:A prospective cohort study in single center institution

Abstract

Lupus nephritis is one of the major manifestations of systemic lupus erythematosus and is responsible for a substantial disease associated with morbidity and mortality. Treatment of it limited by the lack of effective treatment and side effects of the currently available immunosuppressive regimens; this led to a search for other therapeutic agents with potential for the better therapeutic outcome and less side effects like anti CD 20, rituximab. To assess rituximab's efficacy in inducing renal remission in a patient with lupus nephritis compared to cyclophosphamide. Thirty-nine subjects with biopsy-proven lupus nephritis and active disease, divided into two groups, rituximab group (26 patients) and cyclophosphamide group (13 patients), the first group designated to receive rituximab at a dose of 375 mg/m2 every two weeks for a total of 6 doses, and cyclophosphamide group designated to receive cyclophosphamide IV at a dose of 500 mg/m2 every month for a total of 6 cycles. Patients were evaluated every three months for clinical improvement in Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score and renal response achievement for a total of 3 visits (9 months). There was no difference in age or disease duration between 2 groups; disease activity was higher in the cyclophosphamide group. Cyclophosphamide achieved clinical response at nine months, (reduce SLEDAI score from 15.9 to 2.7), while rituximab achieves only partial clinical response (SLEDAI score from 12 to 6). Cyclophosphamide reduces proteinuria from 133 mg/mmol at baseline to 31 mg/mmol at 9 months, while for rituximab from 92 mg/mmol to 67 mg/mmol, at nine months, the complete and incomplete renal response in (84.6%) of patients on cyclophosphamide and in (50%) of patients treated with rituximab, non-responder and relapse seen in (15.4%) of patients treated with cyclophosphamide while in (50%) of those treated with rituximab. (P value=0.036). Cyclophosphamide is more effective than rituximab in inducing remission in patients with Lupus nephritis.