The Renal and Systemic Impact of Rituximabin Patients with Refractory Systemic Lupus Erythematosus

Abstract

Lupus nephritis (LN), a severe complication of systemic lupus erythematosus (SLE), worsens the renal and vital prognosis for up to 50% of SLE patients. Standard treatment involves corticosteroids with cyclophosphamide (CyP) or mycophenolate mofetil (MMF), yet the refractory nature of some cases necessitates alternative therapies. Rituximab (RTX), an anti-CD20 monoclonal antibody, has shown potential in SLE by targeting CD20+ B-cells. However, while some trials, like LUNAR, found RTX’s renal impact inconclusive, others noted its benefit in refractory cases. This retrospective study assessed RTX’s effects on renal and systemic SLE activity in patients unresponsive to conventional immunosuppression. Ten patients, with biopsy-proven refractory SLE (rSLE) received RTX and were monitored for one year. RTX led to a renal response in 80% of cases, with significant proteinuria reduction, stable kidney function, and decreased SLE Disease Activity Index scores. The response correlated with lower baseline chronic lesions and higher anti-dsDNA levels, highlighting potential predictive factors for RTX effectiveness.RTX’s safety profile was generally favorable, with few infections and minimal immune suppression. These findings align with previous studies suggesting RTX benefits patients with rSLE, particularly those with high serological activity. Thus, RTX may serve as a viable adjunct in rSLE management, warranting further exploration of its role in standard SLE care.