Rituximab, a viable alternative for induction therapy of active lupus nephritis: Next steps for evidence-based treatment.

摘要

Despite decades of clinical research aimed at finding the best approaches for the treatment of LN, it remains one of the major disease manifestations of SLE, with great impact on survival and quality of life. The recently recommended induction treatment from Kidney Disease -Improving Global Outcomes (KDIGO) [1], the European League Against Rheumatism (EULAR) [2] and the ACR [3] for diffuse proliferative LN is essentially MMF or i.v. CYC in combination with glucocorticoids. For those who fail to respond to MMF or CYC, switching to the other agent or to rituximab (RTX) is suggested. But with comparatively low-quality evidence as supporting data, clinicians rely on sporadic case reports and observational studies for guidahce. RTX is a chimeric mouse/human monoclonal antibody specific for human CD20, a B cell surface antigen expressed only on mature B cells. As B cells play a key role in the pathogenesis of SLE through both antibody-dependent and antibody-independent mechanisms,