[Renaliste] RE : HELP ( GNEM, Ritux, et Ac )

[Patrick GIRAUD]

Le 6/08/11 9:51, « BAUDEAU, Christophe » <christophe.baudeau at ahparis.org> a
écrit :

> Il est de qui l'article que tu mentionnes ?

Voilà : 

Rituximab-Induced Depletion of Anti-PLA2R Autoantibodies Predicts Response
in Membranous Nephropathy
Laurence H. Beck Jr., Fernando C. Fervenza†, David M. Beck, Ramon G.B.
Bonegio, Fahim A. Malik, Stephen B. Erickson†, Fernando G. Cosio†, Daniel C.
Cattran and David J. Salant

JASN August 1, 2011 vol. 22 no. 8 1543-1550

Abstract :
Autoantibodies to the M-type phospholipase A2 receptor (PLA2R) are sensitive
and specific for idiopathic membranous nephropathy. The anti-B cell agent
rituximab is a promising therapy for this disease, but biomarkers of early
response to treatment currently do not exist. Here, we investigated whether
levels of anti-PLA2R correlate with the immunological activity of membranous
nephropathy, potentially exhibiting a more rapid response to treatment than
clinical parameters such as proteinuria. We measured the amount of
anti-PLA2R using Western blot immunoassay in serial serum samples from a
total of 35 patients treated with rituximab for membranous nephropathy in
two distinct cohorts. Pretreatment samples from 25 of 35 (71%) patients
contained anti-PLA2R, and these autoantibodies declined or disappeared in 17
(68%) of these patients within 12 months after rituximab. Those who
demonstrated this immunologic response fared better clinically: 59% and 88%
attained complete or partial remission by 12 and 24 months, respectively,
compared with 0% and 33% among those with persistent anti-PLA2R levels.
Changes in antibody levels preceded changes in proteinuria. One subject who
relapsed during follow-up had a concomitant return of anti-PLA2R. In
summary, measuring anti-PLA2R levels by immunoassay may be a method to
follow and predict response to treatment with rituximab in membranous
nephropathy.

Correspondence:
Laurence H. Beck, Jr., Renal Section, Evans Biomedical Research Center 504,
650 Albany Street, Boston, MA 02118. Phone: 617-638-7330; Fax: 617-638-7326;
E-mail: lhbeckjr at bu.edu