الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 156 |  |  |
| | | from | 156 | | |
Abstract
Rituximab represents a valid therapeutic option to induce remission in patients with primary glomerulonephritis. Despite several studies proving its efficacy in improving outcomes in patients with idiopathic membranous nephropathy (IMN), its role in therapeutic protocols is not yet defined.
The aim of this study was to describe the efficacy and safety of Rituximab in patients with IMN as secondary immunosuppression in patients who failed ponticelli regimen and to compare it with Cyclosporine.
Our retrospective cohort study included 40 Egyptian patients divided into two equal groups, 20 patients each. Comparable regarding age, sex, blood pressure, createnine, UPCR, albumin and lipid profile.
Cyclosporine Group: received Cyclosporine for secondary immunosuppression, it was given daily for a minimum of 6 months at doses of 3.5 mg/kg orally and
Rituximab Group: received Rituximab for secondary immunosuppression, it was given weekly for 4 weeks at doses of 375 mg/m2 intravenously.
We found:
1) Among Cyclosporine Group, 7 patients (35%) achieved complete remission after 12 months of regular treatment, while 10 (50.0%) achieved partial remission. Relapse of MN occurred only in 3 patients (15.0%).
2) While in Rituximab Group, 1 patient (5%) achieved complete remission after 12 months Rituximab treatment, while 12 (60.0%) achieved partial remission and 2 (10%) have no response. Relapse of IMN was occurred in 5 patients (25.0%).
3) Remission was higher in Cyclosporine group compared to Rituximab group, but the differences were significant only at month-9 of follow up period.
4) There was significant positive correlation between basal eGFR and eGFR reduction among Cyclosporine group.
5) No significant difference between the studied groups regarding serum cholesterol, hemoglobin, TLC, platelets, serum albumin, creatinine and eGFR at different times. eGFR significantly decreased from month-0 to month-12 among Cyclosporine group.
6) No significant difference between the studied groups regarding UPCR at months -0, 1, 3 then became significantly lower in Cyclosporine group. UPCR significantly decreased from month-0 to month-12 among the studied groups. UPCR showed reduction for most times followed by elevation but still lower than month-0 among the studied groups.
7) Reduction in proteinuria >50% was seen in Cyclosporine group compared to 30% in Rituximab group patients (UPCR) was decreased from 5.9 at time 0 to 1.8 at month-6 and decreased from 7.3 at time 0 to 4.1 at month-6 (P=0.005) in Cyclosporine and Rituximab groups respectively. At month-12 UPCR was recorded 2.0 and 4.6 in Cyclosporine and Rituximab groups respectively (P=0.022).
8) Rituximab was tolerated in our study population, with limited side effects without serious adverse events suggesting its safety.