Ofatumumab for multirelapsing membranous nephropathy complicated by rituximab-induced serum-sickness.

Abstract

Rituximab (375 mg/m2) achieved remission of the first episode and six relapses of nephrotic syndrome (NS) in a young male patient with podocyte phospholipase A2 receptor (PLA2R)-related membranous nephropathy (MN) refractory to steroids and cyclosporine. Between-treatments interval averaged 17.4±4.2 months. The seventh infusion was complicated by delayed serum-sickness, which resolved with steroids. On subsequent relapse, the fully human anti-CD20 monoclonal antibody ofatumumab (300 mg) achieved remission of the NS, without significant side effects. Circulating CD19+ B cells were depleted, proteinuria decreased from 10.9 to 1.3 g/day, and serum albumin, immunoglobulin levels and glomerular filtration rate normalised. Twenty-eight months later, despite transient anti-PLA2R depletion, ofatumumab (100 mg) failed to induce remission of the eighth relapse. Remission was safely achieved 5 months later with repeated ofatumumab infusion (300 mg). This treatment (€723) was less expensive than rituximab (€1801). Ofatumumab could be a safe and cost/effective rescue therapy for patients with MN sensitised against rituximab.

• Authors: Manuel Alfredo Podestà, Barbara Ruggiero, Giuseppe Remuzzi, Piero Ruggenenti
• Journal: BMJ case reports (BMJ Case Rep) Vol. 13 Issue 1 (Jan 23 2020) ISSN: 1757-790X [Electronic] England
• PMID: 31980477 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Antibodies, Monoclonal, Humanized
• Rituximab
• ofatumumab

Topics

• Adolescent
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Glomerulonephritis, Membranous (complications, drug therapy)
• Humans
• Male
• Rituximab (adverse effects)
• Serum Sickness (chemically induced, complications)
• Treatment Outcome