Rituximab use in adult glomerulopathies and its rationale

Santos, Joana; Fiel, David; Santos, Ricardo; Vicente, Rita; Aguiar, Rute; Santos, Iolanda; Amoedo, Manuel; Pires, Carlos

doi:10.1590/2175-8239-jbn-2018-0254

Cited by 21 publications

(10 citation statements)

References 91 publications

(130 reference statements)

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“…More recently, rituximab has been effectively used to treat many glomerular diseases, including FSGS[ 47 ]. The exact mechanism of rituximab in the treatment of FSGS is unknown; however, it is believed that rituximab may have a B-cell-independent effect on podocyte cytoskeletal stabilization, in addition to its B-cell depleting effects[ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Rituximab or plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis after kidney transplantation: A systematic review and meta-analysis

Boonpheng¹,

Hansrivijit²,

Mao³

et al. 2021

WJT

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BACKGROUND Focal segmental glomerulosclerosis (FSGS) is one of the most common glomerular diseases leading to renal failure. FSGS has a high risk of recurrence after kidney transplantation. Prevention of recurrent FSGS using rituximab and/or plasmapheresis has been evaluated in multiple small studies with conflicting results. AIM To assess the risk of recurrence of FSGS after transplantation using prophylactic rituximab with or without plasmapheresis, and plasmapheresis alone compared to the standard treatment group without preventive therapy. METHODS This meta-analysis and systematic review were performed by first conducting a literature search of the MEDLINE, EMBASE, and Cochrane databases, from inception through March 2021; search terms included ‘FSGS,’ ’steroid-resistant nephrotic syndrome’, ‘rituximab,’ and ‘plasmapheresis,’. We identified studies that assessed the risk of post-transplant FSGS after use of rituximab with or without plasmapheresis, or plasmapheresis alone. Inclusion criteria were: Original, published, randomized controlled trials or cohort studies (either prospective or retrospective), case–control, or cross-sectional studies; inclusion of odds ratio, relative risk, and standardized incidence ratio with 95% confidence intervals (CI), or sufficient raw data to calculate these ratios; and subjects without interventions (controls) being used as comparators in cohort and cross-sectional studies. Effect estimates from individual studies were extracted and combined using a random effects model. RESULTS Eleven studies, with a total of 399 kidney transplant recipients with FSGS, evaluated the use of rituximab with or without plasmapheresis; thirteen studies, with a total of 571 kidney transplant recipients with FSGS, evaluated plasmapheresis alone. Post-transplant FSGS recurred relatively early. There was no significant difference in recurrence between the group that received rituximab (with or without plasmapheresis) and the standard treatment group, with a pooled risk ratio of 0.82 (95%CI: 0.47-1.45, I 2 = 65%). Similarly, plasmapheresis alone was not associated with any significant difference in FSGS recurrence when compared with no plasmapheresis; the pooled risk ratio was 0.85 (95%CI: 0.60-1.21, I 2 = 23%). Subgroup analyses in the pediatric and adult groups did not yield a significant difference in recurrence risk. We also reviewed and analyzed post-transplant outcomes including timing of recurrence and graft survival. CONCLUSION Overall, the use of rituximab with or without plasmapheresis, or plasmapheresis alone, is not associated with a lower risk of FSGS recurrence after kidney transplantation. Future studies are required to assess the effectiveness of rituximab with or without plasmapheresis among specific patient subgroups with high-risk for FSGS recurrence.

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Section: Discussionmentioning

confidence: 99%

Rituximab or plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis after kidney transplantation: A systematic review and meta-analysis

Boonpheng¹,

Hansrivijit²,

Mao³

et al. 2021

WJT

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“…More recently, rituximab, a pan B cell depleting anti-CD20 monoclonal antibody, has been approved for use instead of cyclophosphamide as a second line of treatment, particularly in AAV. However, although it is not inferior to cyclophosphamide in reducing disease, it induces similar rates of adverse effects, mainly infections, most likely due to hypogammaglobulinaemia and late onset neutropenia (Jones et al, 2015;Santos et al, 2020).…”

Section: Current Therapies For Crescentic Glomerulonephritismentioning

confidence: 99%

Crescentic Glomerulonephritis: Pathogenesis and Therapeutic Potential of Human Amniotic Stem Cells

2021

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Chronic kidney disease (CKD) leads to significant morbidity and mortality worldwide. Glomerulonephritis (GN) is the second leading cause of CKD resulting in end stage renal failure. The most severe and rapidly progressive type of GN is characterized by glomerular crescent formation. The current therapies for crescentic GN, which consist of broad immunosuppressive drugs, are partially effective, non-specific, toxic and cause many serious side effects including infections, cancer, and cardiovascular problems. Therefore, new and safer therapies are needed. Human amniotic epithelial cells (hAECs) are a type of stem cell which are isolated from the placenta after birth. They represent an attractive and novel therapeutic option for the treatment of various inflammatory conditions owing to their unique and selective immunosuppressive ability, as well as their excellent safety profile and clinical applicability. In this review, we will discuss the immunopathogenesis of crescentic GN, issues with currently available treatments and how hAECs offer potential to become a new and harmless treatment option for this condition.

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“…Some have suggested that glucocorticoids are useful in the management of these severe manifestations; however, several studies have shown no benefit over placebo in various measured outcomes [14]. Rituximab has shown some promise in a few studies as well [15,16].…”

Section: Introductionmentioning

confidence: 99%

Adult-Onset IgA Vasculitis Presenting as an Unusual Rash and Pancolitis

Yeo¹,

Kaptur²,

Peterman³

et al. 2022

Cureus

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A 47-year-old female presented with complaints of abdominal pain and a history of new-onset maculopapular rash. A workup including laboratory and imaging studies, colonoscopy, and biopsy was performed that led to the diagnosis of adult-onset IgA vasculitis. The patient responded well to intravenous methylprednisolone and was followed up as an outpatient where she continued with oral methylprednisolone and azathioprine. This case is noteworthy for the unusual adult-onset presentation with primarily gastrointestinal symptoms and atypical rash pattern. Furthermore, while very effective in this patient, the use of corticosteroids is a treatment decision that has some controversy in the current literature.

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Rituximab use in adult glomerulopathies and its rationale

Cited by 21 publications

References 91 publications

Rituximab or plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis after kidney transplantation: A systematic review and meta-analysis

Rituximab or plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis after kidney transplantation: A systematic review and meta-analysis

Crescentic Glomerulonephritis: Pathogenesis and Therapeutic Potential of Human Amniotic Stem Cells

Adult-Onset IgA Vasculitis Presenting as an Unusual Rash and Pancolitis

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