Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy.
Administration, Oral
Adolescent
Adult
Aged
Aged, 80 and over
Cyclosporine
/ adverse effects
Drug Administration Schedule
Female
Glomerulonephritis, Membranous
/ drug therapy
Humans
Immunologic Factors
/ therapeutic use
Immunosuppressive Agents
/ adverse effects
Infusions, Intravenous
Intention to Treat Analysis
Kaplan-Meier Estimate
Male
Middle Aged
Proteinuria
/ drug therapy
Remission Induction
Rituximab
/ adverse effects
Treatment Failure
Young Adult
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
04 07 2019
04 07 2019
Historique:
entrez:
4
7
2019
pubmed:
4
7
2019
medline:
30
7
2019
Statut:
ppublish
Résumé
B-cell anomalies play a role in the pathogenesis of membranous nephropathy. B-cell depletion with rituximab may therefore be noninferior to treatment with cyclosporine for inducing and maintaining a complete or partial remission of proteinuria in patients with this condition. We randomly assigned patients who had membranous nephropathy, proteinuria of at least 5 g per 24 hours, and a quantified creatinine clearance of at least 40 ml per minute per 1.73 m A total of 130 patients underwent randomization. At 12 months, 39 of 65 patients (60%) in the rituximab group and 34 of 65 (52%) in the cyclosporine group had a complete or partial remission (risk difference, 8 percentage points; 95% confidence interval [CI], -9 to 25; P = 0.004 for noninferiority). At 24 months, 39 patients (60%) in the rituximab group and 13 (20%) in the cyclosporine group had a complete or partial remission (risk difference, 40 percentage points; 95% CI, 25 to 55; P<0.001 for both noninferiority and superiority). Among patients in remission who tested positive for anti-phospholipase A Rituximab was noninferior to cyclosporine in inducing complete or partial remission of proteinuria at 12 months and was superior in maintaining proteinuria remission up to 24 months. (Funded by Genentech and the Fulk Family Foundation; MENTOR ClinicalTrials.gov number, NCT01180036.).
Sections du résumé
BACKGROUND
B-cell anomalies play a role in the pathogenesis of membranous nephropathy. B-cell depletion with rituximab may therefore be noninferior to treatment with cyclosporine for inducing and maintaining a complete or partial remission of proteinuria in patients with this condition.
METHODS
We randomly assigned patients who had membranous nephropathy, proteinuria of at least 5 g per 24 hours, and a quantified creatinine clearance of at least 40 ml per minute per 1.73 m
RESULTS
A total of 130 patients underwent randomization. At 12 months, 39 of 65 patients (60%) in the rituximab group and 34 of 65 (52%) in the cyclosporine group had a complete or partial remission (risk difference, 8 percentage points; 95% confidence interval [CI], -9 to 25; P = 0.004 for noninferiority). At 24 months, 39 patients (60%) in the rituximab group and 13 (20%) in the cyclosporine group had a complete or partial remission (risk difference, 40 percentage points; 95% CI, 25 to 55; P<0.001 for both noninferiority and superiority). Among patients in remission who tested positive for anti-phospholipase A
CONCLUSIONS
Rituximab was noninferior to cyclosporine in inducing complete or partial remission of proteinuria at 12 months and was superior in maintaining proteinuria remission up to 24 months. (Funded by Genentech and the Fulk Family Foundation; MENTOR ClinicalTrials.gov number, NCT01180036.).
Identifiants
pubmed: 31269364
doi: 10.1056/NEJMoa1814427
doi:
Substances chimiques
Immunologic Factors
0
Immunosuppressive Agents
0
Rituximab
4F4X42SYQ6
Cyclosporine
83HN0GTJ6D
Banques de données
ClinicalTrials.gov
['NCT01180036']
Types de publication
Equivalence Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
36-46Subventions
Organisme : Medical Research Council
ID : MR/J010847/1
Pays : United Kingdom
Organisme : Genentech
ID : Unrestricted research grant
Pays : International
Investigateurs
F C Fervenza
(FC)
J C Lieske
(JC)
N Leung
(N)
S B Erickson
(SB)
J Radhakrishnan
(J)
A Bomback
(A)
J Hogan
(J)
P Canetta
(P)
W Ahn
(W)
R Lafayette
(R)
N Arora
(N)
P Nargund
(P)
B Rovin
(B)
A Alvarado
(A)
S Parikh
(S)
N Aslam
(N)
I Porter
(I)
P Gipson
(P)
M Kretzler
(M)
B Plattner
(B)
D Gipson
(D)
L Mariani
(L)
P Garg
(P)
P Rao
(P)
J Sedor
(J)
J O'Toole
(J)
J A Jefferson
(JA)
P J Nelson
(PJ)
E McCarthy
(E)
S Yarlagadda
(S)
N Jain
(N)
D Rizk
(D)
J Simon
(J)
S Gebreselassie
(S)
S Blumenthal
(S)
L Beara-Lasic
(L)
O Zhdanova
(O)
L Thomas
(L)
I Cohen
(I)
M Keddis
(M)
A Sussman
(A)
B Thajudeen
(B)
L Juncos
(L)
T Fulop
(T)
I Craici
(I)
S Wagner
(S)
A Dreisbach
(A)
D Monga
(D)
D Green
(D)
A Mattiazzi
(A)
A Nayer
(A)
D Thomas
(D)
L Barisoni
(L)
T Li
(T)
A Vijayan
(A)
D C Cattran
(DC)
H Reich
(H)
M Hladunewich
(M)
S Barbour
(S)
A Levin
(A)
D Philibert
(D)
F Mac-Way
(F)
S Desmeules
(S)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Massachusetts Medical Society.