Rheumatology Advance Access originally published online on January 17, 2006
Rheumatology 2006 45(7):842-846; doi:10.1093/rheumatology/kel004
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Rituximab treatment for glomerulonephritis in HCV-associated mixed cryoglobulinaemia: efficacy and safety in the absence of steroids
Rheumatology Clinic, DPMSC, 1 Internal Medical Clinic, DPMSC, 2 Hematology Clinic, DPMSC, 3 Institute of Pathology, DRMM, University of Udine, and 4 Rheumatology Clinic, Catholic University of Sacred Heart, Rome, Italy.
Correspondence to: S. De Vita, Rheumatology Clinic, University of Udine, Piazzale Santa Maria della Misericordia 1, 33100 Udine, Italy. E-mail: salvatore.devita{at}med.uniud.it
Objective. Rituximab, an anti-CD20 monoclonal antibody, has been used in lupus nephritis and membranous idiopathic nephropathy and has proved effective in non-renal manifestations of type II mixed cryoglobulinaemia (MC) syndrome. We investigated the possible efficacy and safety of rituximab in the treatment of cryoglobulinaemic nephritis.
Methods. Five patients with active, biopsy-proven, glomerulonephritis in hepatitis C virus (HCV)-related type II MC syndrome were treated with four weekly infusions of rituximab (375 mg/m2) in monotherapy, without steroids whenever possible. Rituximab was the first-line therapy in three cases.
Results. A rapid and sustained renal response was observed in all patients, in one of them without retreatment up to the last follow-up (month 21+). Renal biopsy was repeated after 6 months in one patient and histopathological improvement was documented. Three patients relapsed, at months +5, +7 and +12 of follow-up, respectively. Two of them were then retreated with rituximab and again presented a rapid improvement in renal function. Maintenance therapy with rituximab was performed in two patients: nephritis remission was maintained in both. Fc-
receptor 3a (FcRIIIa) genotype characterization was consistent with the clinical response observed. Rituximab also proved effective against other active MC manifestations, when present. No major side-effects occurred and steroids were not required in the follow-up.
Conclusions. Rituximab may provide effective and safe therapy in type II MC-related glomerulonephritis, possibly as first-line therapy, avoiding steroids and hazardous immunosuppressive treatment.
KEY WORDS: Cryoglobulinaemia, Nephritis, Rituximab, Steroid
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