1. Use of rituximab as an induction therapy in anti-glomerular basement-membrane disease
- Author
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Lionel Rostaing, Giovanna Clavarino, M. Heitz, N. Pinel, P.L. Carron, Thomas Jouve, F. Guebre-Egziabher, Service de néphrologie, dialyse, aphérèses et transplantation, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Barrière Naturelle et Infectiosité (TIMC-IMAG-BNI), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service d'immunologie [CHU Grenoble], CHU de Grenoble, Département d'anatomie et cythologie pathologique, and CHU Grenoble-Hôpital Michallon
- Subjects
Nephrology ,Adult ,Male ,medicine.medical_specialty ,Cyclophosphamide ,Adolescent ,Anti-Glomerular Basement Membrane Disease ,medicine.medical_treatment ,030232 urology & nephrology ,Disease ,urologic and male genital diseases ,lcsh:RC870-923 ,Induction therapy ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Antineoplastic Agents, Immunological ,Renal Dialysis ,Internal medicine ,Anti-glomerular basement-membrane disease ,Medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Dialysis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Kidney ,Plasma Exchange ,urogenital system ,business.industry ,fungi ,Remission Induction ,food and beverages ,Goodpasture disease ,Middle Aged ,lcsh:Diseases of the genitourinary system. Urology ,3. Good health ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,medicine.anatomical_structure ,Rituximab ,Female ,business ,medicine.drug ,Follow-Up Studies - Abstract
Background Anti-glomerular basement-membrane (anti-GBM) disease (or Goodpasture disease) is characterized by severe kidney and lung involvement. Prognoses have improved with treatments that combine plasma exchange and immunosuppressive drugs. However, patients with severe renal involvement can have poor renal outcomes and cyclophosphamide can cause significant complications. Anti-GBM antibodies have a direct pathogenic effect on the disease: thus, therapeutics that can decrease their production, such as rituximab, could be a good alternative. Methods The medical files of five patients that had received rituximab as a first-line therapy (instead of cyclophosphamide), plus plasma exchange and steroids, were reviewed. All patients had severe disease manifestations. Results Four patients required dialysis at diagnosis and remained dialysis-dependent over the mean follow-up of 15 months. Three patients had pulmonary involvement, but recovered even though mechanical ventilation was required. Anti-GBM antibodies became rapidly undetectable in all patients. One infectious and two hematological complications were observed. Conclusions We report the outcomes of five patients with Goodpasture disease and treated with rituximab as a first-line treatment. This strategy was effective at treating pulmonary manifestations and was associated with a good biological response with no major serious adverse events. However, renal outcomes were not significantly improved.
- Published
- 2018
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