Rituximab in Addition to Plasma Exchange, Cyclophosphamide, and Steroids for the Treatment of Anti-glomerular Basement Membrane (GBM) Disease
A two-center retrospective study of 78 anti-GBM disease patients found that adding rituximab to standard plasma exchange/cyclophosphamide/steroid therapy did not significantly improve survival or kidney outcomes, though it allowed lower cumulative cyclophosphamide doses.
Background
Anti-GBM disease is usually treated with plasma exchange, cyclophosphamide, and steroids; data on adding B-cell depleting therapy such as rituximab are limited.
Key findings
In this two-center cohort of 78 patients treated between 2003 and 2023, rituximab addition showed non-significant trends toward fewer plasma exchange sessions (10 vs 14) and lower cumulative cyclophosphamide dose (3.3g vs 3.6g), with no significant difference in death (HR 1.45), end-stage kidney disease (HR 0.97), or infection (HR 0.48) risk.
Safety
Rituximab was not associated with an increased risk of infection compared to standard therapy alone, suggesting it may allow clinicians to reduce cyclophosphamide and plasma exchange exposure without compromising safety.
Category
News
Source
Journal of the American Society of Nephrology
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