Combination of Rituximab, Low-Dose Cyclophosphamide, and Prednisone for Primary Membranous Nephropathy: A Case Series With Extended Follow Up

医学 美罗华 强的松 环磷酰胺 四分位间距 内科学 胃肠病学 膜性肾病 单中心 肌酐 外科 泌尿科 肾小球肾炎 化疗 淋巴瘤
作者
Reza Zonozi,Karen Laliberte,Noah Huizenga,Jillian K. Rosenthal,Anushya Jeyabalan,A. Bernard Collins,Frank B. Cortazar,John L. Niles
出处
期刊:American Journal of Kidney Diseases [Elsevier BV]
卷期号:78 (6): 793-803 被引量:39
标识
DOI:10.1053/j.ajkd.2021.04.014
摘要

B-cell depletion with rituximab has emerged as a first-line therapy for primary membranous nephropathy (MN). However, most patients do not achieve complete remission with rituximab monotherapy. In this case series, we report longer-term remission and relapse rates, anti-phospholipase A2 receptor (PLA2R) antibody levels, B-cell levels, and serious adverse events in patients with primary MN who received rituximab combined with an initial short course of low-dose oral cyclophosphamide and a course of rapidly tapered prednisone.Single-center retrospective case series.60 consecutive patients with primary MN treated with the combination of rituximab, low-dose cyclophosphamide, and prednisone at the Vasculitis and Glomerulonephritis Center at the Massachusetts General Hospital.After treatment initiation, median follow-up was 38 (interquartile range [IQR], 25-62) months; 100% of patients achieved partial remission, defined as a urinary protein-creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline, at a median of 3.4 months. By 2 years after treatment initiation, 83% achieved complete remission, defined as a UPCR < 0.3 g/g. The median time to complete remission was 12.4 months. Immunologic remission (defined by an anti-PLA2R titer < 14 RU/mL) was achieved by 86% and 100% of anti-PLA2R seropositive patients (n = 29) at 3 and 6 months, respectively, after treatment initiation. After 1 year, the median UPCR fell from 8.4 (IQR, 5.0-10.7) to 0.3 (IQR, 0.2-0.8) g/g (P < 0.001). No patient relapsed throughout the duration of B-cell depletion. Relapse occurred in 10% of patients at 2 years after the onset of B-cell reconstitution following the last rituximab dose. Over a combined follow-up time of 228 patient-years, 18 serious adverse events occurred. One death occurred unrelated to treatment or primary MN, and 1 patient progressed to kidney failure requiring kidney replacement therapy.Absence of a comparison group.All patients with primary MN treated with combination therapy achieved partial remission and most achieved a durable complete remission with an acceptable safety profile.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
八九完成签到,获得积分10
刚刚
1秒前
干雅柏发布了新的文献求助10
2秒前
Stardust发布了新的文献求助10
2秒前
黑白和完成签到 ,获得积分10
3秒前
yang完成签到,获得积分10
4秒前
金蛋蛋发布了新的文献求助10
5秒前
量子星尘发布了新的文献求助10
7秒前
11秒前
16秒前
淡定的电源完成签到,获得积分10
19秒前
19秒前
lm发布了新的文献求助10
22秒前
24秒前
善学以致用应助孤独问旋采纳,获得10
24秒前
孙燕应助霸气安筠采纳,获得30
25秒前
李健应助科研通管家采纳,获得10
25秒前
汉堡包应助科研通管家采纳,获得10
25秒前
SYLH应助科研通管家采纳,获得20
25秒前
SYLH应助科研通管家采纳,获得10
25秒前
上官若男应助科研通管家采纳,获得10
25秒前
烟花应助科研通管家采纳,获得10
25秒前
丘比特应助科研通管家采纳,获得10
25秒前
SYLH应助科研通管家采纳,获得10
26秒前
CAOHOU应助科研通管家采纳,获得10
26秒前
SYLH应助科研通管家采纳,获得10
26秒前
CAOHOU应助科研通管家采纳,获得10
26秒前
SYLH应助科研通管家采纳,获得10
26秒前
科研通AI2S应助科研通管家采纳,获得10
26秒前
JamesPei应助科研通管家采纳,获得10
26秒前
ding应助科研通管家采纳,获得10
26秒前
26秒前
SYLH应助科研通管家采纳,获得10
26秒前
CAOHOU应助科研通管家采纳,获得10
26秒前
SYLH应助科研通管家采纳,获得20
26秒前
26秒前
28秒前
nbing完成签到,获得积分10
29秒前
十月的天空完成签到,获得积分10
30秒前
31秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989378
求助须知:如何正确求助?哪些是违规求助? 3531442
关于积分的说明 11254002
捐赠科研通 3270126
什么是DOI,文献DOI怎么找? 1804887
邀请新用户注册赠送积分活动 882087
科研通“疑难数据库(出版商)”最低求助积分说明 809173