The LUNAR trial that compared using rituximab to placebo for treatment of Lupus Nephritis is finally in publication. It was a well designed randomized trial that wanted to show the impact of Rituximab given at 4 doses of 1gm each along with steroids and MMF with Class III and IV compared to a group with no rituximab arm. At one year, there was no difference in complete or partial remission. The "lab values" of C4 and C3, and dsDNA were much improved in the rituximab arm but patient outcomes didn't change.
Interestingly, this study suggests that there might be no secondary role for treatment of Lupus with rituximab if MMF and steroids are being used. Steroids were not spared in the rituximab arm, so its hard to see what would have happened if there were no steroids. Also, authors state that the power was not strong enough for better outcomes.
Judge for yourself. Does anti CD20 agents have a future in Lupus Nephritis?
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