Role of Rituximab Therapy in Glomerulonephritis

Jayne, David

doi:10.1681/asn.2008070786

Cited by 41 publications

(26 citation statements)

References 33 publications

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“…Rituximab was first introduced in clinical prac-tice for the treatment of non-Hodgkin's lymphoma and then extended to autoimmune diseases (12), such as rheumatoid arthritis (13), lupus erythematosus (14,15), vasculitic disorders (16), and membranous nephropathy (12,17,18). Recent uncontrolled studies suggest that RTX may maintain remission of INS as effectively as standard therapy based on prednisone and calcineurin inhibitors (19 -22).…”

Section: Introductionmentioning

confidence: 99%

Short-Term Effects of Rituximab in Children with Steroid- and Calcineurin-Dependent Nephrotic Syndrome

Ravani

Magnasco

Edefonti

et al. 2011

Clinical Journal of the American Society of Nephrology

191

148

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SummaryBackground and objectives Prednisone and calcineurin inhibitors are the mainstay therapy of idiopathic nephrotic syndrome (INS) in children. However, drug dependence and toxicity associated with protracted use are common. Case series suggest that the anti-CD20 monoclonal antibody rituximab (RTX) may maintain disease remission. Design, setting, participants, & measurementsThis open-label randomized controlled trial was powered to show that a strategy based on RTX and lower doses of prednisone and calcineurin inhibitors was noninferior to standard doses of these agents in maintaining 3-month proteinuria as low as baseline or up to 1 g/d greater (noninferiority margin). Participants were stratified by the presence of toxicity to prednisone/calcineurin inhibitors and centrally assigned to add RTX (Mabthera, 375 mg/m 2 intravenously) to lower doses of standard agents or to continue with current therapy alone. The risk of relapse was a secondary outcome.Results Fifty-four children (mean age 11 Ϯ 4 years) with INS dependent on prednisone and calcineurin inhibitors for Ͼ12 months were randomized. Three-month proteinuria was 70% lower in the RTX arm (95% confidence interval 35% to 86%) as compared with standard therapy arm (intention-to-treat); relapse rates were 18.5% (intervention) and 48.1% (standard arm) (P ϭ 0.029). Probabilities of being drug-free at 3 months were 62.9% and 3.7%, respectively (P Ͻ 0.001); 50% of RTX cases were in stable remission without drugs after 9 months.Conclusions Rituximab and lower doses of prednisone and calcineurin inhibitors are noninferior to standard therapy in maintaining short-term remission in children with INS dependent on both drugs and allow their temporary withdrawal.

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Section: Introductionmentioning

confidence: 99%

Short-Term Effects of Rituximab in Children with Steroid- and Calcineurin-Dependent Nephrotic Syndrome

Ravani

Magnasco

Edefonti

et al. 2011

Clinical Journal of the American Society of Nephrology

191

148

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“…It is an effective therapy for nonHodgkin's lymphoma and other B cell malignancies (2). Several reports of successful use of rituximab in systemic diseases and immune-mediated renal disorders have been published, including membranous glomerulonephritis, lupus nephritis, vasculitis, mixed cryoglobulinemia, and thrombotic thrombocytopenic purpura (3,4).…”

mentioning

confidence: 99%

Rituximab Treatment of Adult Patients with Steroid-Resistant Focal Segmental Glomerulosclerosis

Fernández‐Fresnedo

Segarra

González

et al. 2009

Clinical Journal of the American Society of Nephrology

108

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Background and objectives: Isolated case reports have shown a beneficial effect of rituximab on pediatric patients with primary FSGS, but there is no information about rituximab treatment of FSGS in adults.Design, setting, participants, & measurements: All patients who had biopsy-proven FSGS and were treated with rituximab in Spain were identified, independent of their positive or negative response, among the nephrology departments that belong to the Spanish Group for the Study of Glomerular Diseases (GLOSEN). Their characteristics and outcome after rituximab treatment were studied.Results: Eight patients were identified. Rituximab failed to improve nephrotic syndrome in five of eight patients, who continued to show massive proteinuria and exhibited a rapidly deteriorating renal function in two cases. Among the remaining three patients, two of them showed an improvement of renal function and a remarkable proteinuria reduction and one experienced a beneficial but transitory effect after rituximab. There were no differences in clinical or laboratory characteristics or in the CD20 B lymphocyte count after rituximab between these three patients and the five who had a negative response. The only difference was in the regimen of rituximab administration: Whereas the five patients with a negative response received only four weekly consecutive infusions of 375 mg/m 2 , the three remaining patients received additional doses of rituximab.Conclusions: Only a minority (three of eight) of patients in our series of adult patients with FSGS showed a positive influence of rituximab. More studies are necessary to characterize further the optimal dosages and the mechanisms of action of rituximab in FSGS.

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“…Subsequently, it was recognized for the treatment of rheumatoid arthritis and vasculitis, and then its use has been indicated for other diseases. In nephrology rituximab has been used in some of both primitive and secondary glomerulonephritis and in the prevention of transplant rejection [47][48][49]. Membranous glomerulonephritis is one the most common causes of the nephrotic syndrome in non-diabetic adults and its treatment is still controversial.…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

“…On the other hand, despite all the drugs available, there are some patients who do not respond to therapies and who progress in the severity of their clinical condition [45]. Therefore, in this group of patients, it seemed appropriate the use of Rituximab, based on the most recent evidences [48,49]. However, because of the great variability of the lupus disease and the absence of large controlled trials, clear indications for rituximab in lupus are still lacking.…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

Glomerulonephritis, Pathogenetic Mechanisms and Therapeutic Options: An Overview

Russo

Musto²,

Testorio³

et al. 2014

J Nephrol Ther

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Introduction: Most forms of human glomerulonephritis (GN) result from immunologic mechanisms that are mediated by the actions of multiple elements of both the innate and adaptive immune systems, thereby resulting in different clinical manifestations. The treatment of immune-mediated kidney disease is based on steroids and immunosuppressive drugs that interfere with the immune processes. These groups of drugs have led to significant benefits, but severe side effects are still frequent. Monoclonal antibodies directed against molecules of inflammation or several cellular components have emerged in clinical practice. Plasmapheresis and new methods to reduce the risks associated with the procedure with standard therapies may be combined. Moreover new therapeutic options have been proposed, as the use of natural anti-inflammatory cytokines or intracellular signaling reducing inflammation.

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Role of Rituximab Therapy in Glomerulonephritis

Cited by 41 publications

References 33 publications

Short-Term Effects of Rituximab in Children with Steroid- and Calcineurin-Dependent Nephrotic Syndrome

Short-Term Effects of Rituximab in Children with Steroid- and Calcineurin-Dependent Nephrotic Syndrome

Rituximab Treatment of Adult Patients with Steroid-Resistant Focal Segmental Glomerulosclerosis

Glomerulonephritis, Pathogenetic Mechanisms and Therapeutic Options: An Overview

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