Long-term effects of anti-CD20 monoclonal antibody treatment of cryoglobulinaemic glomerulonephritis

Abstract

Rituximab appears to be a safe and effective therapeutic option in symptomatic patients with HCV-associated MC glomerulonephritis and signs of systemic vasculitis.

Rituximab-based novel strategies for the treatment of immune-mediated glomerular diseases

“…Both sensory and motor neuropathy improved 1-5 months after RTX [38], [40], [41] and [51]. Interestingly, RTX therapy exerted a steroid-sparing effect on MC [37], and some patients, including cases with active nephritis, were treated ab initio without steroids [39]. RTX also restored some MC-related immune abnormalities [52].…”

“…Encouraging results have been obtained in open-label studies and single case reports. RTX improves or cures various clinical manifestations of MC, including fatigue, purpura and skin ulcers, arthralgias and arthritis, glomerulonephritis (in about 90% of cases), peripheral neuropathy (in about 75% of cases), and hyperviscosity syndrome [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50] and [51]. RTX was also reported to be effective in some life-threatening cases of gastrointestinal vasculitis [43].…”

“…RTX also restored some MC-related immune abnormalities [52]. These effects are concomitant with the disappearance of bone marrow B cell clonal expansion [39] and [53]. A multi-centre, randomized, long-term controlled trial was recently performed in MC patients who failed or were not eligible for antiviral therapy.…”

“…Short-term relapses, within 3-4 months after RTX treatment, occurred in a minority of patients, while long-term responses, lasting more than one year, were the most frequent outcomes. A proposed strategy, in an attempt to delay the relapses, is to administer two more infusions of RTX 1 and 2 months after the standard four week course (4 plus 2 infusion protocol) [39]. Re-treatment with RTX at disease relapse again proved to be effective in most cases [37], [40] and [43] .…”

Mixed cryoglobulinemia

“…For HCV-associated MC, immunomodulating/immunosuppressive treatments should be considered, especially in patients with more severe complications. These treatments include steroids, low-antigen-content (LAC) diet, plasma exchange, and immunosuppressors [3,11,12,24,[116][117][118][119][120][121][122]. In particular, both traditional plasma exchange and double-filtration plasma exchange are able to markedly reduce the levels of circulating immune-complex, especially the cryoglobulins [24,121,122].…”