Purpose: Rituximab, using a multi-dose regimen based on body surface area, has been used for recurrent glomerulonephritis (GN) post-renal transplant with variable success. We examined the efficacy and safety of a single fixed-dose.
Methods: Retrospective study of adult renal recipients transplanted January 2000 March 2012 with recurrent GN treated with fixed-dose rituximab. The primary outcome was complete response (CR): urine protein:creatinine ratio (UPCR) < 0.3. Secondary outcomes: partial response (PR) defined as > 50% reduction in UPCR, time to CR or PR, duration of response, relapse, graft loss, and serious infections. Results are reported as median (range).
Results: 20 patients received 200(100-1000) mg for recurrent disease: FSGS, n=5; lupus (LN), n=5; membranous (MN), n=4; MPGN, n=4; IgA, n=1; and Wegeners (WG), n=1. 8/20 (40%) achieved CR. UPCR pre-rituximab of 4.7 (1.2-10.9) decreased to 0.23 (0.1-0.29). Time to CR was 217(13-590) days. 3/20 (15%) achieved PR. UPCR decreased to 3.3(2.4-7). Time to PR was 137(33-195) days. The duration of response was 587(141-1581) days in 11 responders. 9 were non-responders to the first dose (n=3 FSGS, n=2 MPGN, n=2 LN, n=1 IgA, n=1 MN). 6 non-responders received a second dose, none achieved a CR. 3(50%) achieved a PR in 137(53-219) days. One non-responder received a 3rd dose, but did not respond. Non-responders had a lower UPCR [3.5(1.2-11)], compared to responders [5.3 (1.5-16.4)] prior to the first dose. 2 responders relapsed. One with LN relapsed 258 days after the first dose with UPCR 2.3 from 0.13. Repeat treatment resulted in a second CR of 555 days to date. One with MN relapsed twice; the first 799 days after the first dose (UPCR 1.84 from 0.15). The 2nd dose resulted in a PR of 998 days until UPCR increased to 4.7 from 0.8. The PR is 245 days to date after the 3rd dose. There were 3 graft losses, all in non-responders. There were 3 serious infections post-rituximab: Legionella pneumonia at 45 days, BK viremia at 154 days, and CMV viremia at 92 days. All were treated successfully without complications.
Conclusions: Single fixed-dose rituximab resulted in safe and effective treatment in > 50% with recurrent GN. The relapse rate was low. Non-responders receiving subsequent doses never achieved CR and some had graft loss. A fixed single dose regimen or rituximab for recurrent GN is cost-effective and safe.
To cite this abstract in AMA style:Spinner M, Bowman L, Horwedel T, Santos RDelos, Klein C, Brennan D. Efficacy and Safety of Single Fixed-Dose Rituximab for Recurrent Glomerulonephritis Post-Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/efficacy-and-safety-of-single-fixed-dose-rituximab-for-recurrent-glomerulonephritis-post-transplantation/. Accessed May 16, 2021.
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