#3725 Rituximab efficacy and safety in patients with glomerular diseases: a single centre experience

Abstract Background and Aims Glomerulonephritis is an autoimmune glomerular inflammation that can lead to severe morbidity and mortality if left untreated. Conventional treatment for this condition involves the use of glucocorticoids and immunosuppressive drugs. In recent years, Rituximab has gained popularity as a treatment for several types of glomerular diseases. Rituximab is a monoclonal antibody that targets the CD20 protein expressed on the surface of B cells. Rituximab has shown promising results in the treatment of a variety of glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, ANCA vasculitis, and lupus nephritis. This work was performed to study the efficacy and safety of Rituximab in patients with different glomerular diseases managed with the drug in our renal unit. Method This work was conducted in 2022–2023, retrospectively collecting data of adult patients with different glomerular disease treated with Rituximab between January 2019 and October 2022 in a large teaching hospital in the United Kingdom. Data of patients were collected from the electronic patient records system and patient notes. Results A total of 83 patients were included in the analysis 40 Females and 43 Males. The mean age of all the patients was 56 years with range being 20–89 years. Patients had a range of glomerular diseases for which they were treated. The cohort of patients included patients with different glomerular diseases presenting with nephritic (28 patients) and nephrotic presentations (55 patients). Number of patients according to the disease : ANCA Glomerulonephritis (25), Membranous Nephropathy (18), Minimal Change Disease (15), Lupus Nephritis (10) , Focal Segmental Glomerulosclerosis (9), Immune Complex GN(3), and C1q Nephropathy (2) and mesangial proliferative glomerulonephritis (1). Patients with nephrotic presentations had significant improvement in their Urinary Protein Creatinine Ratio (UPCR) (P = <0.001). There was also significant suppression of B cell load (P = <0.001). We analysed patients presented with both nephritic and nephrotic presentations (81 patients) looking at kidney survival (2 patients excluded as they were on dialysis and had Rituximab for relapse with pulmonary haemorrhage). Only 7 patients (9%) progressed to end stage renal disease (ESRD) and dialysis suggesting Rituximab had (91%) success rate in preserving renal survival and preventing progression to ESRD and dialysis treatment. The length of time B cells stayed suppressed (<1%) was analysed. B cells stayed suppressed for a significant amount of time longer than the six-month dosing schedule of Rituximab (P = <0.001). This suppression was significantly longer in males than females (P < 0.01). The safety of Rituximab was also assessed. Patients received 263 doses during the study period. Fifteen adverse effects were recorded. Five patients sadly died during the study period. Of significance, one patient died due to COVID-19 infection and another one due to septic colonic perforation. Conclusion Rituximab was effective in preserving renal survival and stopping progression to ESRD in patients with the different studied glomerular diseases. It was highly effective in treating proteinuria and suppressing B cells for a significantly longer time than the known six-month period. This point at the possible use of longer dosing interval regimens for patients may be appropriate. Rituximab is a safe drug to use in the patients with glomerulonephritis with clear efficacy in managing renal disease and a good safety profile.