Efficacy and Safety of Rituximab in Lupus Nephritis from a Tertiary Care Rheumatology Clinic in India

Abstract

Background: LUNAR trial failed in lupus nephritis. However case series across the globe have shown good outcome with rituximab in lupus nephritis. So we evaluated the efficacy and safety of rituximab in lupus nephritis in Indian patients Methods: This was single centre, retrospective study done in patients of lupus nephritis receiving rituximab between 2013 to 2022. All patients fulfilled the SLICC criteria. Rituximab was given if there was a flare with background immunosuppression or upfront for early steroid tapering. Patients were followed up at 3, 6 and 12 months. Complete kidney Response (CR) is defined as return of serum creatinine(Scr) to previous level with a decline in 24 hour urine protein to <500 mg at 12 months. (1) Partial kidney response (PR) was defined as an improvement of Scr, but not to the standardized normal, with at least 50% decline in the 24 hour urine protein achieved preferably by 6 months and no later than 12 months following treatment initiation. Results: Out of 125 patients who were included for analysis, CR and PR were achieved in 79(63%) and 18(14%) patients respectively at 12 months. Mean steroid dose in prednisolone equivalent was less than 10 mg at 6 months in all patients. Improvement in parameters like dsDNA, c3, c4 were observed. In follow up 14 patients (11%) developed Chronic kidney disease (CKD), 6 patients (4.8%) required dialysis and 8 patients (6.4%) expired. Subgroup analysis between patients who received rituximab upfront and those after treatment failure or relapse didn’t show statistical difference in results including CR,PR,CKD, dialysis requirement or death. Conclusions: These results indicate the possible efficacy and safety of rituximab based regimen with its potential to reduce the steroid requirement as well as achieving remission in treatment naïve and in patients who are refractory or relapse with standard agents in Indian Subcontinent.