Can "Rituxilup" Spare Steroids in Lupus Nephritis?

Condon MB, Ashby D, Pepper RJ, et al.Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Ann Rheum Dis (2013) 72:1280-1286

A small prospective, observational study suggests that a novel protocol, dubbed “rituxilup,” can achieve complete or partial remission in sizable numbers of lupus nephritis (LN) patients while avoiding oral steroids, without an apparent reduction in efficacy or increase in relapse rates.

British researchers report that 90% of the first 50 consecutive patients at an Imperial College lupus center who were treated with the rituxilup protocol (which includes rituximab and methyl prednisolone followed by mycophenolate mofetil) achieved complete or partial remission by 37 weeks.

After 1 year, 52% (n=26) had reached complete remission and just over a third (34%, n=17) had a partial remission.  These results are analagous to those in trials involving steroids, the authors say.

There were 12 renal relapses in 11 patients, the comparatively low rate suggesting for the first time in 60 years that oral steroids can safely be avoided in LN.

The regimen was well-tolerated with infrequent severe adverse events (18% required an inpatient stay and 10% had an infective episode). Six patients had flares, mostly mild. One patient was lost to follow-up. Two patients died of unrelated causes.

The protocol -- 2 doses of rituximab (1 g) and methyl prednisolone (500 mg) on days 1 and 15, with maintenance using titrated mycophenolate mofetil (MMF, 500 mg twice a day initially then increased to a maximum dose of 1.5 g twice a day) – will now be tested in a randomized multicenter clinical trial.