Rituximab for idiopathic membranous nephropathy

Remuzzi, Giuseppe; Chiurchiu, Carlos; Abbate, Mauro; Brusegan, Verusca; Bontempelli, Mario; Ruggenenti, Piero

doi:10.1016/s0140-6736(02)11042-7

Cited by 325 publications

(258 citation statements)

References 5 publications

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“…36 Small studies have separately characterized efficacy of the anti-CD20 agent rituximab in treatment of chronic graft-versus-host disease, 37 and idiopathic membranous glomerulonephritis. [38][39][40][41] Thus, it is not unexpected that rituximab-treated hematopoietic cell transplantation recipients with biopsy proven membranous glomerulonephritis responded well (three allogeneic and one autologous transplant). Although other reports have demonstrated treatment response with rituximab in hematopoietic cell transplantation patients with membranous glomerulonephritis/nephrotic syndrome, many previously reported patients had only partial remission, and in one case a biopsy was not performed.…”

Section: Discussionmentioning

confidence: 99%

Renal pathology in hematopoietic cell transplantation recipients

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Renal pathology in hematopoietic cell transplantation recipients

et al. 2008

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“…Rituximab binds to the surface of CD20-positive B cells with subsequent activation of the complement system mediating complement-dependent cellular cytotoxicity. In addition, rituximab mediates antibody-dependent cellular cytotoxicity through Fc-receptor binding [53][54][55][56]. However, B-cell depletion per se cannot alone explain the response to rituximab, as B-cell depletion occurs in all treated patients irrespective of the time to response and irrespective of clinical response to rituximab.…”

Section: Discussionmentioning

confidence: 99%

Rituximab chimeric anti‐CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura

et al. 2005

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Idiopathic thrombocytopenic purpura is an autoimmune disease which involves opsonization of platelets by autoantibodies directed against different surface glycoproteins, leading to their premature destruction by the reticuloendothelial system. Management of patients with refractory ITP is difficult. Recent studies have shown that rituximab, a chimeric anti‐CD20 monoclonal antibody, is useful in the treatment of these patients, with overall response rates of about 50%. Most published reports have included a small number patients including case reports. The present study reports the results of a retrospective Danish multicenter study of rituximab in the treatment of adult patients with refractory ITP. Thirty‐five patients (median age 52 years, range 17–82 years, 17 males) were included. One patient had immune thrombocytopenia and neutropenia. All patients had received prednisolone (Pred). Next to Pred, 25 patients had been treated with high‐dose IgG, and in 16 patients a splenectomy had been performed. Sixteen patients had been treated with azathioprine. Other treatments included, e.g., cyclosporine, danazol, cyclophosphamide, vincristine, interferon, and dexamethasone. The patients were treated with a dose regimen of 375 mg/m2 i.v. approximately once weekly for 4 consecutive weeks. Six patients received a fixed dose of 500 mg disregarding their weight supplemented by 100 mg of methylprednisone i.v. or 50–100 mg of Pred given as premedication together with an antihistamine just before infusion of rituximab. The large majority of patients also received Pred and, in some cases, other concomitant immunosuppressive treatment during part of their rituximab treatment. A complete response (CR) was defined as a rise in the platelet count > 100 × 109/L, a partial response (PR) as a rise in the platelet count > 50 × 109/L, and a minor response (MR) as a rise in the platelet count < 50 × 109/L. No response (NR) was defined as no increase in the platelet count. Because 4 patients were treated twice, a total of 39 outcomes of rituximab treatment were evaluated. Rituximab proved to be effective in 17 of 39 treatments [overall response 44% with 7 CR (18%) (1 patient showed a CR twice), 6 PR (15%), and 4 MR (10%)]. In 9/13 cases of CR or PR, the response (platelet level > 50 × 109/L) was prompt, 1–2 weeks after the first infusion. The remaining patients responded 3–8 weeks later. Patients with CR and PR have been in remission for a median of 47 weeks. In general the side effects were few. In 2 cases, the treatment was stopped because of side effects either during or after the first infusion. Two fatal outcomes were recorded. A 71‐year‐old female with severe lung disease died 6 days after the first infusion of respiratory failure. The other patient, a 73‐year‐old man also with severe chronic obstructive lung disease, died of pneumonia approximately 13 weeks following the last rituximab treatment. It is concluded that rituximab may be a useful alternative therapy in patients with severe and symptomatic ITP refractory to conventional treatment. Am. J. Hematol. 78:275–280, 2005. © 2005 Wiley‐Liss, Inc.

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“…Recent research by Beck et al has shown that 70% of patients with idiopathic membranous nephropathy have an auto-antibody to the Mtype phospholipase A2 receptor (PLA2R) that is present on podocytes [9]. Initial studies of RTX in patients with membranous nephropathy demonstrated a variable response, though there were some subjects that had significant improvement [62]. Like many of the other disease processes described, current treatment strategies include steroids, cyclophosphamide and other immunosuppressants, such as calcineurin inhibitors and mycophenolate mofetil.…”

Section: Idiopathic Membranous Nephropathymentioning

confidence: 99%

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

Kattah¹,

Fervenza²,

Roccatello³

2013

Autoimmunity Reviews

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Rituximab is a monoclonal antibody to the CD20 antigen on B-cells that was initially designed and approved for the treatment of non-Hodgkin's B-cell lymphoma in 1997.In the last 15 years, it has emerged as a potent immunosuppressant for many immune-mediated diseases, beginning initially with rheumatoid arthritis, and now extending into several other fields, including clinical nephrology. Based on recent large clinical trials, it is FDA-approved for the treatment of ANCA-associated vasculitis and continues to be studied in off-label usage for many glomerular diseases, including membranous nephropathy, lupus nephritis, and mixed cryoglobulinemia. It has been used as a treatment in nephrotic syndrome in children and adults, including both minimal change disease and focal segmental glomerulosclerosis. Given its efficacy, tolerability and safety profile in comparison to more conventional treatment regimens, RTX is rapidly emerging as a critical treatment modality in glomerular disease.

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Rituximab for idiopathic membranous nephropathy

Cited by 325 publications

References 5 publications

Renal pathology in hematopoietic cell transplantation recipients

Renal pathology in hematopoietic cell transplantation recipients

Rituximab chimeric anti‐CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura

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

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