Abstract: TH-PO590
CD19 Repopulation and Anti-phospholipase A2 Receptor (PLA2R) following Rituximab in Membranous Nephropathy
Session Information
- Membranous Nephropathy, FSGS, and Minimal Change Disease
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
- Kanigicherla, Durga Anil K, Manchester Institute of Nephrology and Transplantation, Manchester, Manchester, United Kingdom
- Hamilton, Patrick, Manchester Institute of Nephrology and Transplantation, Manchester, Manchester, United Kingdom
- Shukkur, Meshaal Mohemed, Manchester Institute of Nephrology and Transplantation, Manchester, Manchester, United Kingdom
- Thet, May Kyaw, Manchester Institute of Nephrology and Transplantation, Manchester, Manchester, United Kingdom
- Ragy, Omar Sherin, Manchester Institute of Nephrology and Transplantation, Manchester, Manchester, United Kingdom
Background
Rituximab is used for treatment in PMN. However, remission rates remain modest, and optimal dosing remains uncertain.
Methods
29 consecutive patients were followed prospectively after rituximab treatment. Clinical markers, Anti-PLA2R, CD19 count (cells/µL) were analysed at 1-week, 2-3-week, 4-6-week, 2-3-month, 4-6-month, 8-10-month, and 12-month.
Results
Features and outcomes are in Table. Remission at 1-year was seen in 15 (52%) patients. All patients had CD19 depletion (<5) between 1-3 weeks. CD19 reconstitution was seen in 6% patients at 4-6 weeks, 25% at 2-3 months, and 60% at 4-6 months. Anti-PLA2R levels reduced at 3 months from baseline but remained at similar level until 12 months. There was significant correlation between CD19 and anti-PLA2R (R=0.89, p= 0.075). Notably, CD19 repopulation preceded rise in anti-PLA2R.
Conclusion
Following rituximab treatment, CD19 levels correlate with anti-PLA2R, repopulation occurs in majority of patients by 4-6 months, and precedes emergence of antiPLA2R. This may explain the modest remission rates in PMN with rituximab and additional dosing at 4-6 months may improve remission.
Baseline & Outcomes
| N | 29 | ||||
| 2019-2023 | |||||
| Males | 66% | ||||
| Age | 56 | ||||
| Biopsy | 29 (100%) | ||||
| Incident-14 Relapse-15 | |||||
| PLA2R-ab +ve | 90% | ||||
| Follow-up | 13.5 mon | ||||
| Remission | 15 (52%) | ||||
| Refractory | 14 (48%) | ||||
| Time0 | 3 mon | 6 mon | 9 mon | 12 mon | |
| Rescue Rx | NA | 0 | 0 | 6 | 0 |
| eGFR | 43 | 43 | 44 | 46 | 44 |
| uPCR | 893 | 582 | 485 | 407 | 177 |
| Alb | 23 | 26 | 27 | 30 | 31 |
| CD19 | 155 | 2 | 13 | 22 | 69 |
| Anti-PLA2R | 88 | 22 | 27 | 18 | 27 |
| Remission | NA | 14% | 21% | 33% | 56% |
Values are median, median & %