Experience of rituximab use in treating glomerular disease in central South Africa

Abstract

Introduction: Most guidelines recommend rituximab for the treatment of various glomerular diseases. However, the high cost deters its use in resource-limited countries. The study aimed to investigate rituximab as treatment for glomerular diseases, and whether this relatively expensive treatment is justifiable in a resource-constrained setting.

Methods: This retrospective cross-sectional study was conducted at the Universitas Academic Hospital Nephrology Clinic in the Free State province of South Africa. Demographic, clinical and laboratory information was obtained from the medical records of patients treated with rituximab from January 2016 to December 2023. The indications for rituximab treatment, number of doses, estimated cost, adverse events and patient outcomes were documented.

Results: Seventeen patients were treated with rituximab during the study period. Most patients (n = 11; 64.7%) were female. The median age was 25 years (interquartile range [IQR] 20–28), and 88.2% were Black. The most common histological diagnoses were membranous nephropathy (n = 7; 41.2%), of which 85.7% were anti-PLAR2 antibody-positive, and lupus nephritis (n = 5; 29.4%). The indication for rituximab was mostly failed previous immunosuppressive therapy (n = 12; 70.6%).Only one patient had an infusion-related reaction. A complete or partial response was recorded in 10 (58.8%) patients. Kidney function deteriorated in one (5.9%) patient, and another demised.

Conclusion: Approximately 60% of the patients achieved a complete or partial response, suggesting that rituximab may be an effective therapy. The cost to treat one patient was high, although it was counteracted by the relative safety reflected by the few adverse events recorded.