Rituximab Therapy for Membranous Nephropathy

Abstract

Results: Twenty-one articles were included for review; all were either case reports or case series without controls. More than half of the published cases (50 of 85) came from one center where rituximab was used as primary immunosuppression for idiopathic MN. The available data suggest that rituximab, dosed either as 375 mg/m 2 once weekly for 4 wk or as 1 g on days 1 and 15, achieves a 15 to 20% rate of complete remission and a 35 to 40% rate of partial remission. The drug was well tolerated with minimal adverse events.Conclusions: Although rituximab may prove to be a better treatment option for MN than alkylating agents or calcineurin inhibitors, the current literature only supports using the drug in research protocols. Whether, when, how, and why to use rituximab in MN remains to be determined.

Evolution in the Understanding of Idiopathic Membranous Nephropathy Pathogenesis: From Experimental Models to the Clinic

“…Важную роль в продукции нефритогенных ан-тител играет Th2-цитокинзависимая активация CD20 + B-лимфоцитов, в связи с чем теоретически обосновано применение при идиопатической МН анти-CD20 + B-клеточных моноклональных анти-тел (ритуксимаба) [27,33]. …”

Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts

“…Longer follow-ups and larger patients are necessitated to definitely establish whether treatment with rituximab does not increase the risk of opportunistic infections or malignancies when used as immunosuppression in second-line (30). Data from a remarkably large series of rituximab therapy in primary glomerular diseases (32) nephropathy (33), lymphoproliferative disorders (34) and autoimmune diseases (35) show that rituximab is safe.…”

Circulating Anti-PLA2R Autoantibodies to Monitor Immunological Activity in Membranous Nephropathy

“…8 Since this initial experience, other groups have consistently reported the efficacy of rituximab in reducing proteinuria in patients with IMN and nephrotic syndrome. 9,10 In confirmation of the superior effectiveness of interventions targeted to specific pathogenetic mechanisms compared with nonspecific immunosuppression, when used as second-line treatment, rituximab safely and persistently reduced proteinuria in IMN patients who had previously failed to respond to steroids, alkylating agents, or calcineurin inhibitors, or who had relapsed after transient remission. 11,12 Finding that selective B cell depletion lowered proteinuria in patients with IMN points to a pathogenetic role of antibody-producing lymphocytes in this disease.…”