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Inicio Revista Colombiana de Reumatología (English Edition) Outcomes with the use of rituximab in patients with refractory lupus nephritis i...
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Vol. 31. Issue 2.
Pages 143-149 (April - June 2024)
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Vol. 31. Issue 2.
Pages 143-149 (April - June 2024)
Original Investigation
Outcomes with the use of rituximab in patients with refractory lupus nephritis in a Colombian cohort
Desenlaces con el uso de rituximab en pacientes con nefritis lúpica refractaria en una cohorte colombiana
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Julián Barbosa-Aranaa, Juan David López-Lópeza, Sebastián Guerra-Zaramaa, Santiago Monsalve-Yepesa, María Fernanda Saavedra-Chacóna, José David Serna-Giraldoa, Juan Camilo Díaz-Coronadoa,b, Diego Fernando Rojas-Gualdrona, Deicy Hernandez-parrab,
Corresponding author
deicyhepa@gmail.com

Corresponding author.
, Sebastián Herrerab
a Faculty of Medicine, Universidad CES, Medellín, Colombia
b Departamento de Medicina Interna, Grupo de Información Clínica Artmedica IPS, Medellín, Colombia
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Tables (5)
Table 1. Characteristics of the participants.
Table 2. Response to previous treatments and cumulative dose.
Table 3. Histological and renal characteristics.
Table 4. Response to treatment with RTX.
Table 5. Difference in health state utility between responders and non-responders to treatment with rituximab.
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Abstract
Introduction/Objective

To describe the safety and response to treatment with RTX, estimating its impact on the health state utility (HSU) of patients with refractory lupus nephritis (LN) treated in referral centres in several cities in Colombia.

Materials and methods

A registry-based follow-up study. Patients aged between 16 and 75 years, who were refractory to first-line management and had ISN / RPS class III-IV (+/- V) LN, were included. Our primary outcome was total or partial response to treatment; secondary outcomes were HSU measured with the EQ-5D-3 L, and safety of treatment with RTX. The impact analysis of response to RTX on HSU were performed by mean difference estimated by robust regression.

Results

Forty-six patients (44 women) were included, with a median age of 34 years (IQR = 13), the median SDI was 1 (IQR = 1) and the median activity measured by SLEDAI was 4.5 (IQR = 5.9). Response to RTX was observed in 27 (58.7%) patients. Adjusted for SLEDAI and co-interventions, the patients who responded to RTX obtained a higher mean HSU by 0.162 (95% CI 0.006–0.317). Which is equivalent to 1.9 (95% CI 0.2–3.8) more months lived in ideal health conditions for each year with refractory LN. In 54.3% of the patients, RTX had adequate safety.

Conclusion

From the patient's perspective, the response to treatment with RTX in patients with refractory LN implies a significant impact on their quality of life.

Keywords:
Lupus nephritis
Rituximab
Refractory lupus nephritis
Resumen
Introducción/Objetivo

Describir la seguridad y la respuesta al tratamiento con RTX, estimando su impacto en la utilidad del estado de salud de pacientes con nefritis lúpica (NL) refractaria tratados en un centro de referencia de varias ciudades de Colombia.

Materiales y métodos

Estudio de seguimiento a una cohorte basado en registros. Se incluyeron pacientes con edades entre 16 y 75 años, a quien se les documentó NL clase III-IV (+/− V) según criterios de la International Society of Nephrology/Renal Pathology Society (ISN/RPS), refractarios al manejo de primera línea. Como desenlace principal se definió la respuesta total o parcial al tratamiento, y como desenlaces secundarios, la utilidad del estado de salud (UES) medida mediante el EQ-5D-3 y la seguridad al tratamiento con RTX. Los análisis de impacto en la UES se realizaron mediante diferencias de medias según respuesta de tratamiento con regresión robusta.

Resultados

Se incluyeron 46 pacientes (44 mujeres), con una edad mediana de 34 años (RIC = 13), mediana de SDI de 1 (RIC = 1) y mediana de actividad por SLEDAI de 4,5 (RIC = 5,9). Se observó respuesta al RTX en 27 (58,7%) pacientes. Con ajuste por SLEDAI y cointervenciones, los pacientes que respondieron al RTX obtuvieron una media de UES mayor en 0,162 (IC 95% 0,006−0,317), lo cual equivale a 1,9 (IC 95% 0,2–3,8) meses más del tiempo vivido en condiciones de salud ideal por cada año con NL refractaria. El 54,3% de los pacientes tuvo una adecuada seguridad al RTX.

Conclusión

Desde la perspectiva del paciente, la respuesta a tratamiento con RTX en pacientes con NL refractaria implica un impacto relevante en su calidad de vida.

Palabras clave:
Nefritis lúpica
Rituximab
Nefritis lúpica refractaria

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