Rheumatology Advance Access published online on January 17, 2006
Rheumatology, doi:10.1093/rheumatology/kel004
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1 Rheumatology Clinic, DPMSC, University of Udine, Italy
* To whom correspondence should be addressed. 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- 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.
Received September 8, 2005
Accepted October 6, 2005
Original Papers
Rituximab treatment for glomerulonephritis in HCV-associated mixed cryoglobulinaemia: efficacy and safety in the absence of steroids
L. Quartuccio 1,
G. Soardo 2,
G. Romano 1,
F. Zaja 3,
C. A. Scott 4,
G. De Marchi 1,
M. Fabris 1,
G. Ferraccioli 5,
and
S. De Vita 1 *
2 Internal Medical Clinic, DPMSC, University of Udine, Italy
3 Hematology Clinic, DPMSC, University of Udine, Italy
4 Institute of Pathology, DRMM, University of Udine, University of Udine, Italy
5 Rheumatology Clinic, Catholic University of Sacred Heart, Rome, Italy
S. De Vita, E-mail: salvatore.devita{at}med.uniud.it
Abstract 
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.
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