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Case report
Ofatumumab for multirelapsing membranous nephropathy complicated by rituximab-induced serum-sickness
  1. Manuel Alfredo Podestà1,2,
  2. Barbara Ruggiero1,3,
  3. Giuseppe Remuzzi1 and
  4. Piero Ruggenenti1,2
  1. 1Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
  2. 2Unit of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
  3. 3Division of Nephrology, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
  1. Correspondence to Professor Giuseppe Remuzzi; giuseppe.remuzzi{at}marionegri.it

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.

  • renal medicine
  • rheumatology
  • immunology
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Footnotes

  • Contributors Supervised by PR and GR. The patient was under the care of BR, the report was written by MAP and PR, and the final version of the manuscript was revised and approved by all contributors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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