{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T20:25:16Z","timestamp":1788639916946,"version":"build-2803163510"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001259","name":"National Kidney Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001259","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>B-cell depletion with anti-CD20 agents has been evaluated as part of induction immunosuppression (IS) in lupus nephritis (LN). Data on its long-term efficacy for maintenance of remission remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective case series evaluating outcomes in patients with relapsing, refractory and severe LN at diagnosis who received rituximab (RTX)-induced continuous B-cell depletion for both induction and maintenance at Massachusetts General Hospital from 2008 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 26 patients with active LN were included. Eighty-eight percent (23\/26) had class III\/IV\u00a0\u00b1\u00a0V on kidney biopsy; 12% (3\/26) had pure class V LN. Median follow-up (from first to last RTX) was 32\u00a0months [interquartile range (IQR) 14\u201368]; median cumulative dose of RTX was 10\u00a0g (IQR 6\u201317). At RTX initiation, all patients received prednisone and oral IS with an intention to taper off oral agents in 12\u00a0months. Eighty-one percent (21\/26) achieved at least partial remission. Median prednisone dose decreased from 30 to 5\u00a0mg\/day at 6\u00a0months (P\u00a0&amp;lt;\u00a0.01). Fifty-eight percent (15\/26) of patients at 12\u00a0months and 79% (11\/14) at 24\u00a0months were on RTX monotherapy. Six renal relapses occurred in five patients with median time-to-first relapse of 43\u00a0months (range 24\u2013142); all episodes but one were preceded by B-cell repopulation. Five patients developed end-stage kidney disease; all had creatinine &amp;gt;2\u00a0mg\/dL at RTX initiation. Thirty-one percent (8\/26) experienced severe infections requiring hospitalization. No deaths occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Long-term continuous B-cell depletion may be an effective treatment strategy in patients with LN who have failed prior IS or with severe disease at diagnosis. Future controlled studies are needed to further evaluate this approach as the backbone therapy in LN.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfag152","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T11:18:49Z","timestamp":1778498329000},"source":"Crossref","is-referenced-by-count":1,"title":["Long-term B-cell depletion with rituximab in relapsing, refractory and severe lupus nephritis: a retrospective case series"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4959-7437","authenticated-orcid":false,"given":"Qiyu","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Nephrology, Mass General Brigham Department of Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-9061","authenticated-orcid":false,"given":"Orhan","family":"Efe","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mass General Brigham Department of Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Al\u00a0Jurdi","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mass General Brigham Department of Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harish","family":"Seethapathy","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mass General Brigham Department of Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7389-4549","authenticated-orcid":false,"given":"Reza","family":"Zonozi","sequence":"additional","affiliation":[{"name":"International Kidney Vasculitis and Glomerular Center , Fairfax, VA ,","place":["USA"]},{"name":"Nephrology Associates of Northern Virginia , Fairfax, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Sauvage","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mass General Brigham Department of Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Laliberte","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mass General Brigham Department of Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Niles","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mass General Brigham Department of Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anushya","family":"Jeyabalan","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mass General Brigham Department of Medicine, , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"2026070100364133000_bib1","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.autrev.2019.03.004","article-title":"Refractory lupus nephritis: when, why and how to treat","volume":"18","author":"Kronbichler","year":"2019","journal-title":"Autoimmun Rev"},{"key":"2026070100364133000_bib2","doi-asserted-by":"publisher","first-page":"734","DOI":"10.2215\/CJN.10601016","article-title":"Clinical and histopathologic characteristics associated with renal outcomes in lupus nephritis","volume":"12","author":"Rijnink","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026070100364133000_bib3","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1097\/MAJ.0b013e31827f4ee3","article-title":"Lupus nephritis and end-stage kidney disease","volume":"346","author":"Maroz","year":"2013","journal-title":"Am J Med Sci"},{"key":"2026070100364133000_bib4","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1093\/rheumatology\/kev311","article-title":"The frequency and outcome of lupus nephritis: results from an international inception cohort study","volume":"55","author":"Hanly","year":"2016","journal-title":"Rheumatology"},{"key":"2026070100364133000_bib5","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1136\/annrheumdis-2020-218272","article-title":"Update \u03bfn the diagnosis and management of systemic lupus erythematosus","volume":"80","author":"Fanouriakis","year":"2021","journal-title":"Ann Rheum Dis"},{"key":"2026070100364133000_bib6","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1681\/ASN.2008101028","article-title":"Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis","volume":"20","author":"Appel","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"2026070100364133000_bib7","doi-asserted-by":"publisher","first-page":"2083","DOI":"10.1136\/ard.2010.131995","article-title":"Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial","volume":"69","author":"Houssiau","year":"2010","journal-title":"Ann Rheum Dis"},{"key":"2026070100364133000_bib8","doi-asserted-by":"publisher","first-page":"1962","DOI":"10.2215\/CJN.00490109","article-title":"Predictors of relapse and end stage kidney disease in proliferative lupus nephritis: focus on children, adolescents, and young adults","volume":"4","author":"Gibson","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026070100364133000_bib9","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.1177\/0961203311418269","article-title":"Efficacy and safety of enteric-coated mycophenolate sodium in combination with two glucocorticoid regimens for the treatment of active lupus nephritis","volume":"20","author":"Zeher","year":"2011","journal-title":"Lupus"},{"key":"2026070100364133000_bib10","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1038\/s41584-024-01158-w","article-title":"Lupus nephritis-related chronic kidney disease","volume":"20","author":"Lichtnekert","year":"2024","journal-title":"Nat Rev Rheumatol"},{"key":"2026070100364133000_bib11","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1002\/art.34359","article-title":"Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study","volume":"64","author":"Rovin","year":"2012","journal-title":"Arthritis Rheum"},{"key":"2026070100364133000_bib12","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.2215\/CJN.01070118","article-title":"Peripheral blood B cell depletion after rituximab and complete response in lupus nephritis","volume":"13","author":"Gomez\u00a0Mendez","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026070100364133000_bib13","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1136\/annrheumdis-2021-220920","article-title":"B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial","volume":"81","author":"Furie","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"2026070100364133000_bib14","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1056\/NEJMoa2410965","article-title":"Efficacy and safety of obinutuzumab in active lupus nephritis","volume":"392","author":"Furie","year":"2025","journal-title":"N Engl J Med"},{"key":"2026070100364133000_bib15","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.1038\/s41591-022-02017-5","article-title":"Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus","volume":"28","author":"Mackensen","year":"2022","journal-title":"Nat Med"},{"key":"2026070100364133000_bib16","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1002\/art.42734","article-title":"kidney outcomes and preservation of kidney function with obinutuzumab in patients with lupus nephritis: a post hoc analysis of the NOBILITY trial","volume":"76","author":"Rovin","year":"2024","journal-title":"Arthritis Rheumatol"},{"key":"2026070100364133000_bib17","doi-asserted-by":"publisher","first-page":"245","DOI":"10.2174\/1573397115666190626111847","article-title":"The prevalence and causes of non-adherence to immunosuppressive medications in patients with lupus nephritis flares","volume":"16","author":"Ali","year":"2020","journal-title":"Curr Rheumatol Rev"},{"key":"2026070100364133000_bib18","doi-asserted-by":"publisher","first-page":"736","DOI":"10.2215\/CJN.07340713","article-title":"Long-term maintenance therapy using rituximab-induced continuous B-cell depletion in patients with ANCA vasculitis","volume":"9","author":"Pendergraft","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026070100364133000_bib19","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1016\/j.anai.2023.01.018","article-title":"Hypogammaglobulinemia, late-onset neutropenia, and infections following rituximab","volume":"130","author":"Athni","year":"2023","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2026070100364133000_bib20","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1056\/NEJMoa1014460","article-title":"Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis","volume":"365","author":"Dooley","year":"2011","journal-title":"N Engl J Med"},{"key":"2026070100364133000_bib21","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1093\/ndt\/gfs285","article-title":"Beyond the LUNAR trial. Efficacy of rituximab in refractory lupus nephritis","volume":"28","author":"Weidenbusch","year":"2013","journal-title":"Nephrol Dial Transplant"},{"key":"2026070100364133000_bib22","doi-asserted-by":"publisher","first-page":"2458","DOI":"10.1002\/art.27541","article-title":"Safety and efficacy of rituximab in systemic lupus erythematosus: results from 136 patients from the French AutoImmunity and Rituximab registry","volume":"62","author":"Terrier","year":"2010","journal-title":"Arthritis Rheum"},{"key":"2026070100364133000_bib23","doi-asserted-by":"publisher","first-page":"3586","DOI":"10.1093\/ndt\/gfq256","article-title":"Long-term efficacy and safety of rituximab in refractory and relapsing systemic lupus erythematosus","volume":"25","author":"Catapano","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"2026070100364133000_bib24","doi-asserted-by":"publisher","first-page":"3038","DOI":"10.1002\/art.30466","article-title":"B cell biomarkers of rituximab responses in systemic lupus erythematosus","volume":"63","author":"Vital","year":"2011","journal-title":"Arthritis Rheum"},{"key":"2026070100364133000_bib25","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1136\/ard.2007.083162","article-title":"Variability in the biological response to anti-CD20 B cell depletion in systemic lupus erythaematosus","volume":"67","author":"Albert","year":"2008","journal-title":"Ann Rheum Dis"},{"key":"2026070100364133000_bib26","doi-asserted-by":"publisher","first-page":"2601","DOI":"10.1093\/rheumatology\/keac608","article-title":"Anti-rituximab antibodies demonstrate neutralizing capacity, associate with lower circulating drug levels and earlier relapse in lupus","volume":"62","author":"Wincup","year":"2022","journal-title":"Rheumatology"},{"key":"2026070100364133000_bib27","doi-asserted-by":"publisher","first-page":"2672","DOI":"10.1002\/art.38074","article-title":"Elevated serum BAFF levels are associated with rising anti-double-stranded DNA antibody levels and disease flare following B cell depletion therapy in systemic lupus erythematosus","volume":"65","author":"Carter","year":"2013","journal-title":"Arthritis Rheum"},{"key":"2026070100364133000_bib28","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1186\/s13075-021-02589-6","article-title":"First exposure to rituximab is associated to high rate of anti-drug antibodies in systemic lupus erythematosus but not in ANCA-associated vasculitis","volume":"23","author":"Faustini","year":"2021","journal-title":"Arthritis Res Ther"},{"key":"2026070100364133000_bib29","doi-asserted-by":"publisher","first-page":"100291","DOI":"10.1016\/j.eclinm.2020.100291","article-title":"Adults with systemic lupus exhibit distinct molecular phenotypes in a cross-sectional study","volume":"20","author":"Guthridge","year":"2020","journal-title":"EClinicalMedicine"},{"key":"2026070100364133000_bib30","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1007\/s00296-019-04272-1","article-title":"Tolerability and safety of long-term rituximab treatment in systemic inflammatory and autoimmune diseases","volume":"39","author":"Vikse","year":"2019","journal-title":"Rheumatol Int"},{"key":"2026070100364133000_bib31","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s12905-021-01423-0","article-title":"Inflammatory vaginitis in women on long-term rituximab treatment for autoimmune disorders","volume":"21","author":"Yockey","year":"2021","journal-title":"BMC Womens Health"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfag152\/68269197\/sfag152.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/6\/sfag152\/68269197\/sfag152.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/6\/sfag152\/68269197\/sfag152.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:22:37Z","timestamp":1782912157000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfag152\/8676039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfag152","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,11]]},"article-number":"sfag152"}}