Dr Breanna Hollow1, Dr Ashley Irish1, Dr Harish Puttagunta1, Ms Sharon Ho1, Dr Ramyasuda Swaminathan1
1Fiona Stanley Hospital, Murdoch, Australia
Biography:
Dr Breanna Hollow is a third-year Basic Physician Trainee based at Fiona Stanley Hospital in Perth, Western Australia. She has a special interest in nephrology and hopes to pursue a career in this field.
Aim:
To audit rituximab prescription for glomerulonephritis (GN) at a nephrology centre in Western Australia over a ten-year period and ascertain the proportion of patients achieving remission and relapse rates in an extended range of GN.
Background:
Rituximab’s tolerability compared with traditional immunosuppressive regimes have made it an attractive agent in the treatment of an expanding number of GN. Changing prescribing patterns and rituximab efficacy in focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD) and fibrillary GN remain poorly characterised.
Methods:
This single-centre case series included all patients with biopsy-confirmed GN diagnosed between 1 January 2015 and 30 November 2024 who received rituximab. Data was obtained from electronic medical records and cross-referenced with institutional rituximab prescriptions. Complete remission (CR), partial remission (PR) and relapse were defined as per the 2021 Kidney Disease Improving Global Outcomes Glomerular Disease Guidelines.
Results:
137/1146 (11.9%) of patients with GN received rituximab. The most common indications were membranous GN (n = 39; 28.5%), MPO-positive ANCA vasculitis (n= 22; 16.1%), lupus nephritis (n= 13; 9.5%) and PR3-positive ANCA vasculitis (n= 12; 8.8%). Less frequent indications included FSGS (n=11; 8.0%), MCD (n= 11; 8.0%) and fibrillary GN (n=4; 2.9%). Among FSGS patients treated at our institution (n= 6), 1 achieved CR, 3 PR, and 2 patients did not respond. Of MCD patients (n=10), 8 achieved CR and 1 PR. Only 3 subsequently relapsed within the 10-year follow-up period. No patients with fibrillary GN achieved CR; 1 achieved PR.
Conclusion:
Rituximab was effective in inducing sustained remission in MCD. In contrast, complete remission was infrequent in FSGS and absent in fibrillary GN. Larger studies are required to evaluate rituximab’s role in these conditions.