Kidney Week

Abstract: TH-PO638

Obinutuzumab for Treatment of Refractory Lupus Nephritis

Session Information

• Lupus Nephritis: Clinical, Outcomes, and Therapeutics
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Singh, Tripti, University of Wisconsin-Madison, Madison, Wisconsin, United States

Tripti Singh, MD, MBBS, FASN

• Gomez, Shelby, UW Health, Madison, Wisconsin, United States

Shelby Gomez, PharmD

• Panzer, Sarah E., University of Wisconsin-Madison, Madison, Wisconsin, United States

Sarah E. Panzer, MD

• Ferguson, Sancia K., University of Wisconsin-Madison, Madison, Wisconsin, United States

Sancia K. Ferguson, MD, MPH

• Garg, Shivani, University of Wisconsin-Madison, Madison, Wisconsin, United States

Shivani Garg, MD, MS

Background

Despite advances, the rates of complete and partial remission remain low in LN. B cell depletion with rituximab has been shown to be effective and is recommended by KDIGO for treatment of refractory LN after verifying adherence to treatment. Obinutuzumab has shown efficacy in addition to mycophenolate mofetil (MMF) in LN. However, the role of Obinutuzumab in refractory LN remains elusive. We studied the efficacy of Obinutuzumab in refractory LN.

Methods

8 patients with refractory LN were included in the study. Patients received Obinutuzumab 1000 mg, 2 doses, two weeks apart.

Results

Patients included in the study had kidney biopsy with class IV LN (25%), class IV and V LN (25%), class III and V LN (25%) and class II and V LN (25%). Mean age of patients was 29.6 years, 75% were females, 50% were of white race, 13% were Asian race and 38% were Hispanic ethnicity. All patients were on angiotensin convertase inhibitor (ACE-i) or angiotensin receptor blocker (ARB), and 87.5% of patients were on MMF and hydroxychloroquine, 62% were on tacrolimus, and 12.5% on azathioprine. Among this cohort, 75% had been on cyclophosphamide, 50% had been on rituximab, 50% on voclosporin and 37.5% had been on belimumab. Mean duration of follow up was 118 days. After treatment with Obinutuzumab, there was a significant decrease in proteinuria (mean protein: creatinine ratio 2.6 gm/gm vs 1.2 gm/gm, p-value = 0.01, Table 1). There was also significant improvement in mean serum albumin (2.9 gm/dL vs 3.2 gm/dL, p-value 0.03) and serum C4 levels (14 mg/dL vs 17 mg/dL, p-value= 0.02). Additionally, there was a trend in improvement in eGFR (62 ml/min/1.73m² vs 71 ml/min/1.73m², p-value= 0.19) and serum C3 levels (78 mg/dL vs 87 mg/dL, p-value= 0.23) (Table 1). One patient had shingles 2 months after the Obinutuzumab infusion.

Conclusion

Obinutuzumab therapy along with MMF, HCQ and ACE-i was associated with significant improvement in proteinuria, serum albumin and serum C4 levels in patients with refractory LN. Obinutuzumab could be considered as a treatment option for refractory LN.