Rituximab in Membranous Nephropathy

Abstract

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A Review of Therapy for Primary Membranous Nephropathy Post-MENTOR

“…Primary membranous nephropathy (PMN) is the most common cause of nephrotic syndrome in adults, accounting for 20-40% of all cases. It is an autoimmune disease with an incidence rate of 1.2 per 100,000 persons per year, and a male to female ratio of 2:1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The discovery of autoantibodies to phospholipase A2 receptor (PLA2R) by Beck and Salant in 2009 revolutionized our understanding of the pathophysiology of this unique disease [2].…”

“…PLA2R, a normal molecule in the podocyte structure, serves as the target antigen for PLA2R antibodies, causing an immunological response that results in the clinical signs of proteinuria and hypoalbuminemia [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Furthermore, the identification of this antigen and antibody has had a significant impact on the treatment approach.…”

“…The purpose of this review is to illustrate the changing landscape of PMN therapy post-MEN-TOR, highlighting alternative therapies including rituximab and other agents that have been used more recently instead of the tried and tested cyclical regimen consisting of corticosteroids, alkylating agents, and calcineurin inhibitors. Alkylating agents and calcineurin inhibitors have significant adverse effects, including gonadal toxicity, bone marrow suppression, oncogenic effects, and nephrotoxicity [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…Since Ponticelli's seminal paper was published in the New England Journal of Medicine in 1984, cyclical therapy with alkylating agents has been regarded as the gold standard therapy for PMN. This therapeutic approach is effective as remission rates reportedly vary from 77% to 93% [6]. Of concern is that these agents are associated with an adverse risk profile that includes malignancy, gonadal toxicity, infection, dermatological manifestations, and bone marrow suppression, thus requiring caution in their use [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…This therapeutic approach is effective as remission rates reportedly vary from 77% to 93% [6]. Of concern is that these agents are associated with an adverse risk profile that includes malignancy, gonadal toxicity, infection, dermatological manifestations, and bone marrow suppression, thus requiring caution in their use [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”