Keberhasilan Terapi Rituximab pada Seorang Pasien dengan Lupus Nephritis Berat: Laporan Kasus

Ni Putu Dewi Indriyani; Pande Ketut Kurniari; Gede Kambayana

doi:10.15562/ism.v11i3.631

Keberhasilan Terapi Rituximab pada Seorang Pasien dengan Lupus Nephritis Berat: Laporan Kasus

Ni Putu Dewi Indriyani ,

Pande Ketut Kurniari ,

Gede Kambayana ,

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DOI: https://doi.org/10.15562/ism.v11i3.631 |
Published: 2020-12-01

Abstract

Background: Lupus nephritis is one of complication of systemic lupus erythematosus (SLE) which manifests to the kidneys. Lupus nephritis occur in 50-60% of cases in the first ten years of the onset of SLE. Standard therapy for lupus nephritis are immunosuppressive drugs such as corticosteroids and cytostatics. In a refracter case, biologic agent has giving new hope.

Case description: We report a case of seventeen years old female with chief complaints of edema in both feet, skin rash caused by sun exposure, joint pain, mouth ulcer with positive ANA test, proteinuria and high blood sugar level. Patient was then diagnosed with SLE, lupus nephritis and other types of DM. Patient was treated with combination theraphy of cycloposphamide and Rituximab. Patient then discharged in good condition.

Conclusion: we suggest that combination of cycloposphamide and Rituximab is effective in controlling SLE and reducing the dose of steroid theraphy.

Keyword: biological agents, systemic lupus erythematosus, lupus nephritis

Latar belakang: Lupus nephritis merupakan salah satu komplikasi penyakit Systemic Lupus Erythematosus (SLE) yang bermanifestasi ke ginjal. Komplikasi lupus nephritis terjadi pada 50-60% kasus dalam sepuluh tahun pertama onset penyakit SLE. Terapi lupus nephritis meliputi obat-obatan imunosupresif seperti kortikosteroid dan sitostatika. Pada kasus-kasus yang refrakter, terapi dengan agen biologis memberikan harapan baru. Harapan hidup jangka panjang dan renal survival pasien SLE dengan lupus nephritis secara progresif telah mengalami peningkatan sejak ditemukannya agen biologis, rujukan yang lebih dini, dan kriteria diagnostik yang lebih baik.

Deskripsi kasus:Kami melaporkan kasus seorang perempuan, berusia 17 tahun, suku Timor, datang dengan keluhan utama bengkak pada kedua punggung kaki, kemerahan pada kulit bila terkena sinar matahari, nyeri sendi, ulserasi pada mulut, dengan hasil laboratorium ANA test positif, proteinuria, disertai kadar gula darah yang tinggi. Pasien didiagnosis dengan SLE, lupus nephritis, dan DM Tipe lain. Setelah diberikan terapi cycloposphamide dan Rituximab, kondisi pasien membaik. Kesimpulan: regimen terapi ini efektif untuk mengontrol penyakit SLE dan memungkinkan untuk penurunan dosis terapi steroid.

References

Thanaka Y, Takeuchi T, Miyasaka N, Sumida T, Mimori T, Koike T, et al. Original Article : Efficacy and Safety of Rituximab in Japanese Patients with Systemic Lupus Erythematosus and Lupus Nephritis Who Are Refractory To Conventional Therapy. Mod Rheumatol. 2016; 26(1): p.80-86.
Sutoko B. Gambaran Klinik dan Diagnosis Lupus Eritematosus Sistemik. Dalam: Buku Ajar Ilmu Penyakit Dalam. 6th ed. Jakarta: Interna Publishing. 2014; p. 3351 – 3359.
Feldman CH, Hiraki LT, Liu J, Fischer MA, Solomon DH, Alarcon GS, et al. Epidemiology and Sosiodemographics of Systemic Lupus Erythematosus and Lupus Nephritis among U.S. Adults with Medicaid Coverage, 2000-2004. Arthritis Rheum. 2013; 65(3): p.753-763.
Hahn BH, McMahon MA, Wilkinson A, Wallace D, et al. American College of Rheumatology Guidelines for Screening, Treatment, and Management of Lupus Nephritis. Arthritis Care & Research. 2012; 64(6): p.797-808.
Kasjmir YI, Handono K, Wijaya LK, Hamijoyo L, Albar Z, Kalim H, Hermansyah, Kertia N, Achadiono DNW, Manuaba IARW, Suarjana N, Dewi S, Ongkowijaya JA. Diagnosis dan Pengelolaan Lupus Eritematosus Sistemik. Rekomendasi Perhimpunan Reumatologi Indonesia. 2011; p.1-46.
Dharmeizar, Bawazier LA. Diagnosis dan Penatalaksanaan Nefritis Lupus. Dalam: Buku Ajar Ilmu Penyakit Dalam. 6th ed. Jakarta: Interna Publishing. 2014; p. 3378 – 3383.
Ponticelli C. Diagnostic & Therapeutic Corner: New Therapy for Lupus Nephritis. Clin J Am Soc Nephrol. 2006; 1: p.863-868.
Fanouriakis A, Bertsias G. Management of Refractory Lupus Nephritis. EMJ Nephrol. 2015; 3(1): p. 83-89.
Kalloo S, Aggarwal N, Mohan P. Lupus Nephritis: Treatment of Resistant Disease. Clin J Am Soc Nephrol. 2013; 8:p.154-161.
Merill JT, Neuwelt M, Wallace DJ, Shanahan JC, Latinis KM, Oates JC, et al. Efficacy and Safety of Rituximab in Moderately-to-Severely active Systemic Lupus Erythematosus. The Randomized, Double Blind, Phase II/III SLE Evaluation of Rituximab Trial. Arthritis & Rheumatism. 2010; 62 (1): p. 222-233.
Jiang B, Li T,Chen S, et al. Original Article : Efficacy and Safety of Rituximab in Systemic Lupus Erythematosus and Sjoigren Syndrome Patients with Refractory Thrombocytopenia, A Retrospective Study of 21 cases. J Clin Rheumatol. 2015; 21(5): p. 244-250.
Chan TM. Reviews : Treatment of severe lupus nephritis: the new horizon. Nat. Rev. Nephrol. 2014; p. 1-13.
Alshaiki F, Obaid E, Almuallim A, Taha R, Haddad HE, Almoallim H. Outcomes of Rituximab Therapy in Refractory Lupus: a meta-analysis. Eur J Rheumatol. 2018; 1-9.
Nixon A, Ogden L, Woywodt A, Dhaygude A. Infectious Complications of Rituximab Therapy in Renal Disease. Clin Kidney J. 2017; 10(4): 455-60.
Kelesidis T, Daikos G, Boumpas D, Tsiodras S. Does Rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis. 2011;15: e2-e16.

[1] Thanaka Y, Takeuchi T, Miyasaka N, Sumida T, Mimori T, Koike T, et al. Original Article : Efficacy and Safety of Rituximab in Japanese Patients with Systemic Lupus Erythematosus and Lupus Nephritis Who Are Refractory To Conventional Therapy. Mod Rheumatol. 2016; 26(1): p.80-86.

[2] Sutoko B. Gambaran Klinik dan Diagnosis Lupus Eritematosus Sistemik. Dalam: Buku Ajar Ilmu Penyakit Dalam. 6th ed. Jakarta: Interna Publishing. 2014; p. 3351 – 3359.

[3] Feldman CH, Hiraki LT, Liu J, Fischer MA, Solomon DH, Alarcon GS, et al. Epidemiology and Sosiodemographics of Systemic Lupus Erythematosus and Lupus Nephritis among U.S. Adults with Medicaid Coverage, 2000-2004. Arthritis Rheum. 2013; 65(3): p.753-763.

[4] Hahn BH, McMahon MA, Wilkinson A, Wallace D, et al. American College of Rheumatology Guidelines for Screening, Treatment, and Management of Lupus Nephritis. Arthritis Care & Research. 2012; 64(6): p.797-808.

[5] Kasjmir YI, Handono K, Wijaya LK, Hamijoyo L, Albar Z, Kalim H, Hermansyah, Kertia N, Achadiono DNW, Manuaba IARW, Suarjana N, Dewi S, Ongkowijaya JA. Diagnosis dan Pengelolaan Lupus Eritematosus Sistemik. Rekomendasi Perhimpunan Reumatologi Indonesia. 2011; p.1-46.

[6] Dharmeizar, Bawazier LA. Diagnosis dan Penatalaksanaan Nefritis Lupus. Dalam: Buku Ajar Ilmu Penyakit Dalam. 6th ed. Jakarta: Interna Publishing. 2014; p. 3378 – 3383.

[7] Ponticelli C. Diagnostic & Therapeutic Corner: New Therapy for Lupus Nephritis. Clin J Am Soc Nephrol. 2006; 1: p.863-868.

[8] Fanouriakis A, Bertsias G. Management of Refractory Lupus Nephritis. EMJ Nephrol. 2015; 3(1): p. 83-89.

[9] Kalloo S, Aggarwal N, Mohan P. Lupus Nephritis: Treatment of Resistant Disease. Clin J Am Soc Nephrol. 2013; 8:p.154-161.

[10] Merill JT, Neuwelt M, Wallace DJ, Shanahan JC, Latinis KM, Oates JC, et al. Efficacy and Safety of Rituximab in Moderately-to-Severely active Systemic Lupus Erythematosus. The Randomized, Double Blind, Phase II/III SLE Evaluation of Rituximab Trial. Arthritis & Rheumatism. 2010; 62 (1): p. 222-233.

[11] Jiang B, Li T,Chen S, et al. Original Article : Efficacy and Safety of Rituximab in Systemic Lupus Erythematosus and Sjoigren Syndrome Patients with Refractory Thrombocytopenia, A Retrospective Study of 21 cases. J Clin Rheumatol. 2015; 21(5): p. 244-250.

[12] Chan TM. Reviews : Treatment of severe lupus nephritis: the new horizon. Nat. Rev. Nephrol. 2014; p. 1-13.

[13] Alshaiki F, Obaid E, Almuallim A, Taha R, Haddad HE, Almoallim H. Outcomes of Rituximab Therapy in Refractory Lupus: a meta-analysis. Eur J Rheumatol. 2018; 1-9.

[14] Nixon A, Ogden L, Woywodt A, Dhaygude A. Infectious Complications of Rituximab Therapy in Renal Disease. Clin Kidney J. 2017; 10(4): 455-60.

[15] Kelesidis T, Daikos G, Boumpas D, Tsiodras S. Does Rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis. 2011;15: e2-e16.

Keberhasilan Terapi Rituximab pada Seorang Pasien dengan Lupus Nephritis Berat: Laporan Kasus

Abstract

References

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