Publications by authors named "Anushya Jeyabalan"

8 Publications

  • Page 1 of 1

Eculizumab and Complement Activation in Anti-glomerular Basement Membrane Disease.

Kidney Int Rep 2021 Oct 12;6(10):2713-2717. Epub 2021 Jul 12.

Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1016/j.ekir.2021.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484114PMC
October 2021

Association of renal transplantation with reduced risk of myocardial infarction and ischemic stroke in ANCA-associated vasculitis: An observational cohort study.

Semin Arthritis Rheum 2021 Sep 26;51(6):1180-1185. Epub 2021 Sep 26.

Clinical Epidemiology Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address:

Objective: Myocardial infarction and ischemic stroke are leading causes of cardiovascular (CV) morbidity and mortality in ANCA-associated vasculitis (AAV), especially for the 20% with end-stage renal disease (ESRD). We assessed the impact of renal transplantation on the risk of myocardial infarction and stroke among patients with ESRD due to AAV.

Methods: We identified patients from the United States Renal Data System with ESRD due to AAV between 2000 and 2016. We examined the association between renal transplantation and the risk of non-fatal and fatal myocardial infarction or ischemic stroke among waitlisted patients using Medicare claims and death data through 2017. We used time-varying Cox proportional hazards models with age as the time scale to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for myocardial infarction and ischemic stroke events among patients who received a renal transplant compared to those who remained on the waitlist.

Results: Of 1029 waitlisted patients, 593 (58%) were transplanted over a mean of 5.7 years. There were 17 events (4.6/1,000 person-years) in the transplanted group and 40 events (13.7/1,000 person-years) in the group that remained waitlisted. A renal transplant was associated with a 78% lower risk of myocardial infarction or ischemic stroke (HR=0.22, 95% CI 0.11 to 0.47). These findings persisted across sex and age groups and when censoring patients after living donor transplantation.

Conclusions: Among AAV patients with ESRD, renal transplantation can substantially reduce the risk of myocardial infarction and ischemic stroke. Improving access to transplantation for this population may further improve outcomes.
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http://dx.doi.org/10.1016/j.semarthrit.2021.09.007DOI Listing
September 2021

Combination of Rituximab, Low-Dose Cyclophosphamide, and Prednisone for Primary Membranous Nephropathy: A Case Series With Extended Follow Up.

Am J Kidney Dis 2021 12 24;78(6):793-803. Epub 2021 Jun 24.

Vasculitis and Glomerulonephritis Center, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.

Rationale & Objective: B-cell depletion with rituximab has emerged as a first-line therapy for primary membranous nephropathy (MN). However, most patients do not achieve complete remission with rituximab monotherapy. In this case series, we report longer-term remission and relapse rates, anti-phospholipase A receptor (PLAR) antibody levels, B-cell levels, and serious adverse events in patients with primary MN who received rituximab combined with an initial short course of low-dose oral cyclophosphamide and a course of rapidly tapered prednisone.

Study Design: Single-center retrospective case series.

Setting & Participants: 60 consecutive patients with primary MN treated with the combination of rituximab, low-dose cyclophosphamide, and prednisone at the Vasculitis and Glomerulonephritis Center at the Massachusetts General Hospital.

Findings: After treatment initiation, median follow-up was 38 (interquartile range [IQR], 25-62) months; 100% of patients achieved partial remission, defined as a urinary protein-creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline, at a median of 3.4 months. By 2 years after treatment initiation, 83% achieved complete remission, defined as a UPCR < 0.3 g/g. The median time to complete remission was 12.4 months. Immunologic remission (defined by an anti-PLAR titer < 14 RU/mL) was achieved by 86% and 100% of anti-PLAR seropositive patients (n = 29) at 3 and 6 months, respectively, after treatment initiation. After 1 year, the median UPCR fell from 8.4 (IQR, 5.0-10.7) to 0.3 (IQR, 0.2-0.8) g/g (P < 0.001). No patient relapsed throughout the duration of B-cell depletion. Relapse occurred in 10% of patients at 2 years after the onset of B-cell reconstitution following the last rituximab dose. Over a combined follow-up time of 228 patient-years, 18 serious adverse events occurred. One death occurred unrelated to treatment or primary MN, and 1 patient progressed to kidney failure requiring kidney replacement therapy.

Limitations: Absence of a comparison group.

Conclusions: All patients with primary MN treated with combination therapy achieved partial remission and most achieved a durable complete remission with an acceptable safety profile.
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http://dx.doi.org/10.1053/j.ajkd.2021.04.014DOI Listing
December 2021

Rituximab in Membranous Nephropathy.

Kidney Int Rep 2021 Apr 13;6(4):881-893. Epub 2021 Jan 13.

Division of Nephrology, Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany.

Membranous nephropathy (MN) is the most common cause of primary nephrotic syndrome among adults. The identification of phospholipase A2 receptor (PLA2R) as target antigen in most patients changed the management of MN dramatically, and provided a rationale for B-cell depleting agents such as rituximab. The efficacy of rituximab in inducing remission has been investigated in several studies, including 3 randomized controlled trials, in which complete and partial remission of proteinuria was achieved in approximately two-thirds of treated patients. Due to its favorable safety profile, rituximab is now considered a first-line treatment option for MN, especially in patients at moderate and high risk of deterioration in kidney function. However, questions remain about how to best use rituximab, including the optimal dosing regimen, a potential need for maintenance therapy, and assessment of long-term safety and efficacy outcomes. In this review, we provide an overview of the current literature and discuss both strengths and limitations of "the new standard."
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http://dx.doi.org/10.1016/j.ekir.2020.12.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071613PMC
April 2021

COVID-19 Recovery Without B Cells or Antibodies in Patients Receiving Rituximab for Autoimmune Disease.

Iran J Kidney Dis 2021 03;1(2):159-160

Massachusetts General Hospital, Boston, MA, USA.

No Abstract.
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March 2021

Familial Fibrillary Glomerulonephritis in Living Related Kidney Transplantation.

Kidney Int Rep 2021 Jan 31;6(1):239-242. Epub 2020 Oct 31.

Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, New York, USA.

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http://dx.doi.org/10.1016/j.ekir.2020.10.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783556PMC
January 2021

Rituximab in adult minimal change disease and focal segmental glomerulosclerosis - What is known and what is still unknown?

Autoimmun Rev 2020 Nov 15;19(11):102671. Epub 2020 Sep 15.

Department of Nephrology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

Primary forms of minimal change disease and focal segmental glomerulosclerosis are rare podocytopathies and clinically characterized by nephrotic syndrome. Glucocorticoids are the cornerstone of the initial immunosuppressive treatment in these two entities. Especially among adults with minimal change disease or focal segmental glomerulosclerosis, relapses, steroid dependence or resistance are common and necessitate re-initiation of steroids and other immunosuppressants. Effective steroid-sparing therapies and introduction of less toxic immunosuppressive agents are urgently needed to reduce undesirable side effects, in particular for patients whose disease course is complex. Rituximab, a B cell depleting monoclonal antibody, is increasingly used off-label in these circumstances, despite a low level of evidence for adult patients. Hence, critical questions concerning drug-safety, long-term efficacy and the optimal regimen for rituximab-treatment remain unanswered. Evidence in the form of large, multicenter studies and randomized controlled trials are urgently needed to overcome these limitations.
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http://dx.doi.org/10.1016/j.autrev.2020.102671DOI Listing
November 2020

Paraneoplastic Focal Segmental Glomerulosclerosis Associated With Acute Lymphocytic Leukemia.

Kidney Int Rep 2019 Oct 25;4(10):1494-1498. Epub 2019 Jun 25.

Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

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http://dx.doi.org/10.1016/j.ekir.2019.06.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829180PMC
October 2019
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