奥图穆马
医学
美罗华
膜性肾病
肾病综合征
内科学
胃肠病学
蛋白尿
泌尿科
微血尿
免疫学
CD20
肾
淋巴瘤
作者
Manuel Alfredo Podestà,Barbara Ruggiero,Giuseppe Remuzzi,Piero Ruggenenti
出处
期刊:Case Reports
[BMJ]
日期:2020-01-01
卷期号:13 (1): e232896-e232896
被引量:38
标识
DOI:10.1136/bcr-2019-232896
摘要
Rituximab (375 mg/m 2 ) achieved remission of the first episode and six relapses of nephrotic syndrome (NS) in a young male patient with podocyte phospholipase A 2 receptor (PLA 2 R)-related membranous nephropathy (MN) refractory to steroids and cyclosporine. Between-treatments interval averaged 17.4±4.2 months. The seventh infusion was complicated by delayed serum-sickness, which resolved with steroids. On subsequent relapse, the fully human anti-CD20 monoclonal antibody ofatumumab (300 mg) achieved remission of the NS, without significant side effects. Circulating CD19 + B cells were depleted, proteinuria decreased from 10.9 to 1.3 g/day, and serum albumin, immunoglobulin levels and glomerular filtration rate normalised. Twenty-eight months later, despite transient anti-PLA 2 R depletion, ofatumumab (100 mg) failed to induce remission of the eighth relapse. Remission was safely achieved 5 months later with repeated ofatumumab infusion (300 mg). This treatment (€723) was less expensive than rituximab (€1801). Ofatumumab could be a safe and cost/effective rescue therapy for patients with MN sensitised against rituximab.
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