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      A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction.

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          Abstract

          IgA nephropathy frequently leads to progressive CKD. Although interest surrounds use of immunosuppressive agents added to standard therapy, several recent studies have questioned efficacy of these agents. Depleting antibody-producing B cells potentially offers a new therapy. In this open label, multicenter study conducted over 1-year follow-up, we randomized 34 adult patients with biopsy-proven IgA nephropathy and proteinuria >1 g/d, maintained on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers with well controlled BP and eGFR<90 ml/min per 1.73 m2, to receive standard therapy or rituximab with standard therapy. Primary outcome measures included change in proteinuria and change in eGFR. Median baseline serum creatinine level (range) was 1.4 (0.8-2.4) mg/dl, and proteinuria was 2.1 (0.6-5.3) g/d. Treatment with rituximab depleted B cells and was well tolerated. eGFR did not change in either group. Rituximab did not alter the level of proteinuria compared with that at baseline or in the control group; three patients in each group had ≥50% reduction in level of proteinuria. Serum levels of galactose-deficient IgA1 or antibodies against galactose-deficient IgA1 did not change. In this trial, rituximab therapy did not significantly improve renal function or proteinuria assessed over 1 year. Although rituximab effectively depleted B cells, it failed to reduce serum levels of galactose-deficient IgA1 and antigalactose-deficient IgA1 antibodies. Lack of efficacy of rituximab, at least at this stage and severity of IgA nephropathy, may reflect a failure of rituximab to reduce levels of specific antibodies assigned salient pathogenetic roles in IgA nephropathy.

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          Author and article information

          Journal
          J. Am. Soc. Nephrol.
          Journal of the American Society of Nephrology : JASN
          American Society of Nephrology (ASN)
          1533-3450
          1046-6673
          Apr 2017
          : 28
          : 4
          Affiliations
          [1 ] Division of Nephrology and Hypertension, Stanford University, Stanford, California.
          [2 ] Division of Nephrology and Hypertension, Columbia University Medical Center, New York, New York.
          [3 ] Division of Nephrology, Ohio State University, Columbus, Ohio.
          [4 ] Departments of Microbiology and.
          [5 ] Division of Nephrology and Hypertension.
          [6 ] Department of Laboratory Medicine and Pathology, and.
          [7 ] Division of Nephrology, University of Tennessee, Chattanooga, Tennessee; and.
          [8 ] Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
          [9 ] Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
          [10 ] Department of Immunology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic.
          [11 ] Division of Nephrology and Hypertension, fervenza.fernando@mayo.edu.
          Article
          ASN.2016060640
          10.1681/ASN.2016060640
          5373458
          27821627

          rituximab, proteinuria, IgA nephropathy

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