Complete remission of lupus nephritis with rituximab and steroids for induction and rituximab alone for maintenance therapy

Lupus nephritis (LN) is a severe and frequent complication of systemic lupus erythematosus. For decades, cyclophosphamide-based regimens have been the gold standard in treating patients with LN. However, cyclophosphamide use is associated with increased morbidity and mortality, and thus alternative treatments are needed. We report 3 cases of severe class IV LN successfully treated with rituximab as an induction, as well as a long-term maintenance, treatment. Complete remission of LN, documented by means of a control kidney biopsy, occurred in all patients and was maintained during follow-up using rituximab as sole maintenance treatment. No severe infectious complications were observed during treatment with rituximab. Our data suggest that rituximab may prove to be an optimal maintenance treatment in patients with severe LN.