利妥昔单抗治疗狼肾并非100有效

利妥昔单抗治疗狼疮肾炎并非100%有效

作者：Mankee A，et al
翻译：北三医院 邓晓莉（13683657545@163.com）
校正：北医三院 张警丰 刘湘源

摘要：利妥昔单抗是一种人鼠嵌合的抗CD20单克隆抗体，被用来作为一种免疫抑制剂治疗环磷酰胺无效的狼疮肾炎患者，以诱导缓解。虽然非对照的病例系列研究证实其有效，但这一结论还没被前瞻性、随机对照研究证实。本研究目的是回顾性分析在单中心接受利妥昔单抗的狼疮肾炎患者的资料。1例患者对治疗反应很好，且没有并发症。第二例患者首次利妥昔单抗治疗反应很好，但随后在第二次治疗时出现短暂性肾功能和肾病综合征的恶化。另外5例患者均在利妥昔单抗治疗后出现临床恶化。2例患者出现短暂的肾功能和肾病综合征的恶化，其中1例患者随后对治疗有反应。第5例患者出现肾病综合征和肾功能的恶化，之后虽然有改善但仍然比利妥昔单抗治疗前差。第6例患者在利托西单抗治疗后出现急进性肾功能不全，肾穿提示活动性狼疮肾炎，最后需要大剂量激素和环磷酰胺的挽救治疗。第7例患者在利妥昔单抗治疗后出现肾病综合征和肾外表现的恶化。对治疗反应好的2例患者B细胞清除很完全，而B细胞清除不完全可能是另外几例患者病情恶化的一个原因。我们的经验提示，利妥昔单抗治疗红斑狼疮不是没有风险的，病情还不一定有效，这一点在治疗前一定要告知患者。
附原文：
Rituximab is a chimeric anti-CD20monoclonal antibody that is used as an immunosuppressive agent incyclophosphamide refractory lupus nephritis toinduce remission. Although uncontrolled case series suggest efficacy, this isnot yet supported by evidence from prospective randomized controlled trials.The objective of this retrospective case series is to report the clinicaloutcome of seven patients who received rituximabfor lupus nephritis in a single centre between2011 and 2014. One patient had clinical evidence of an uncomplicated responseto therapy. A second patient responded well with the first rituximab course, but had transient worsening of renalfunction and nephrotic syndrome with a second course. The other five patientsall had evidence of a clinical deterioration following rituximab.Two had transient worsening of both renal function and nephrotic syndrome, withsubsequent evidence of response in one of these. A fifth patient showedevidence of worsening nephrotic syndrome and renal function which then improvedbut with renal function remaining below the level present before rituximab. A sixth developed rapidly progressive renalfailure following rituximab with active nephritison renal biopsy and required rescue therapy with high dose steroids andcyclophosphamide. A seventh developed a transient worsening of her nephroticsyndrome and an exacerbation of extrarenal symptoms following rituximab. The two patients showing a good response hadcomplete B cell depletion and incomplete depletion may be a factor in thedeterioration seen in the other patients. Our experience suggests that rituximab therapy in lupusnephritis is not without risk and patients should be informed of thisbeforehand. This is particularly important in view of the uncertainty that rituximab will offer a therapeutic benefit.
引自：Manou-Stathopoulou S, Robson MG. Risk of clinical deterioration in patients with lupus nephritis receiving rituximab.Lupus. 2016 Apr 15. pii: 0961203316641768.