Rituximab treatment for glomerulonephritis in HCV-associated mixed cryoglobulinaemia: efficacy and safety in the absence of steroids

Rheumatology (Oxford). 2006 Jul;45(7):842-6. doi: 10.1093/rheumatology/kel004. Epub 2006 Jan 17.


Objective: Rituximab, an anti-CD20 monoclonal antibody, has been used in lupus nephritis and membranous idiopathic nephropathy and has proved effective in non-renal manifestations of type II mixed cryoglobulinaemia (MC) syndrome. We investigated the possible efficacy and safety of rituximab in the treatment of cryoglobulinaemic nephritis.

Methods: Five patients with active, biopsy-proven, glomerulonephritis in hepatitis C virus (HCV)-related type II MC syndrome were treated with four weekly infusions of rituximab (375 mg/m2) in monotherapy, without steroids whenever possible. Rituximab was the first-line therapy in three cases.

Results: A rapid and sustained renal response was observed in all patients, in one of them without retreatment up to the last follow-up (month 21+). Renal biopsy was repeated after 6 months in one patient and histopathological improvement was documented. Three patients relapsed, at months +5, +7 and +12 of follow-up, respectively. Two of them were then retreated with rituximab and again presented a rapid improvement in renal function. Maintenance therapy with rituximab was performed in two patients: nephritis remission was maintained in both. Fc-gamma receptor 3a (FcgammaRIIIa) genotype characterization was consistent with the clinical response observed. Rituximab also proved effective against other active MC manifestations, when present. No major side-effects occurred and steroids were not required in the follow-up.

Conclusions: Rituximab may provide effective and safe therapy in type II MC-related glomerulonephritis, possibly as first-line therapy, avoiding steroids and hazardous immunosuppressive treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Cryoglobulinemia / complications*
  • Drug Administration Schedule
  • Drug Evaluation
  • Female
  • Glomerulonephritis / drug therapy*
  • Glomerulonephritis / genetics
  • Glomerulonephritis / pathology
  • Glucocorticoids / administration & dosage
  • Hepatitis C / complications*
  • Humans
  • Male
  • Middle Aged
  • Polymorphism, Genetic
  • Receptors, IgG / genetics
  • Recurrence
  • Rituximab
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antiviral Agents
  • FCGR3A protein, human
  • Glucocorticoids
  • Receptors, IgG
  • Rituximab