Efficacy and safety of individualized rituximab in proliferative lupus nephritis

Abstract The dosage, efficacy and safety of Rituximab (RTX) in the treatment of proliferative lupus nephritis (PLN) have not been fully investigated. We collected the data episodes from January 2017 to July 2023 of patients with PLN who were hospitalized in the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University and treated with RTX, and the renal remission, recurrence and adverse reactions after RTX treatment were analyzed retrospectively. A total of 22 patients were enrolled, including 7 patients who were treated as a naive and 15 relapsed/refractory patients, 4 patients required hemodialysis on admission. After the first treatment of RTX, a total of 21(95.45%) patients achieved B cell depletion, and a total of 15 patients (68.18%) achieved complete response (CR). The annual average frequency of relapse per individual in the maintenance remission period in 15 refractory/relapsing patients decreased from (0.494±0.346) times to (0.026±0.010) time (P＜0.001), and the maintenance doses of prednisone decreased from (14.17±9.39) mg/day [ 20.0（12.3，40.0）months] to (8.67±5.97) mg/d[ 12.0（10.0,15.0）months] (P=0.040). Infection occurred in 3 patient within the first 3 months after RTX treatment and recovered after treatment, 3 cases were removed from hemodialysis, and no patient died. In conclusion, RTX can effectively treat PLN, reduce frequency of recurrences and decrease the dose of glucocorticoids, without increasing the occurrence of increased infection risks.