Kidney Outcomes in ANCA-Glomerulonephritis According to Induction Immunosuppression and Histopathology.
In crescentic antineutrophil cytoplasmic autoantibody-glomerulonephritis, rituximab alone raised kidney failure risk vs cyclophosphamide
Kidney Outcomes in ANCA-Glomerulonephritis According to Induction Immunosuppression and Histopathology.
Cyclophosphamide (cyclophosphamide) and rituximab (rituximab), alone or combined, are the mainstays of induction therapy in antineutrophil cytoplasmic autoantibody (antineutrophil cytoplasmic autoantibody)-glomerulonephritis.
This is a retrospective, multicenter study including patients with biopsy-proven antineutrophil cytoplasmic autoantibody-glomerulonephritis.
Rituximab-only patients had over 3-fold higher rate of kidney failure than cyclophosphamide-treated patients
The cohort included 304 patients; median baseline eGFR was 20 ml/min per 1.73 m 2 (interquartile range [IQR]: 11-35).
Induction immunosuppression was with cyclophosphamide in 59%, with rituximab in 17%, and with rituximab-cyclophosphamide in 24%.
In the crescentic class, the rituximab group had lower chances of eGFR recovery than cyclophosphamide (odds ratio [OR]: 0.23, 95% confidence interval [CI]: 0.05-0.98, P = 0.047); the trend was similar in comparison with rituximab-cyclophosphamide (OR: 0.20, 95% CI: 0.03-1.19, P = 0.077).
No significant differences were observed in the other Berden classes.
Patients with crescentic class antineutrophil cytoplasmic autoantibody-glomerulonephritis receiving rituximab monotherapy may have worse kidney outcomes than those treated with cyclophosphamide-based regimens.
Further studies are needed to validate these results and better understand how to personalize treatment.