Successful Treatment of Membranous Glomerulonephritis with Rituximab in Calcineurin Inhibitor-Dependent Patients

Segarra, Alfons; Praga, Manuel; Ramos, Natália; Polanco, Natalia; Cargol, Isabel; Gutiérrez‐Solís, Elena; Gómez, Manuel; Montoro, Bruno; Camps, Joaquim

doi:10.2215/cjn.06041108

Cited by 83 publications

(42 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An interesting treatment strategy to overcome dependence of CNI (and thus prevent relapses after drug withdrawal) was proposed by Segarra et al [65] In a study of 13 patients with at least four previous CNI-responsive relapses of nephrotic proteinuria, rituximab treatment (4 weekly doses of 375 mg/m 2 ) enabled CNIs to be successfully withdrawn in all patients. After CNI withdrawal, only three patients suffered from a relapse (19,23, and 28 months after rituximab treatment), all of them were successfully treated with a second course of rituximab.…”

Section: Treatmentmentioning

confidence: 99%

Pharmacological treatment of primary membranous nephropathy in 2016

Logt¹,

Hofstra²,

Wetzels³

2016

Expert Review of Clinical Pharmacology

View full text Add to dashboard Cite

show abstract

Section: Treatmentmentioning

confidence: 99%

Pharmacological treatment of primary membranous nephropathy in 2016

Logt¹,

Hofstra²,

Wetzels³

2016

Expert Review of Clinical Pharmacology

View full text Add to dashboard Cite

show abstract

“…3,4 Finding that rituximab therapy achieved disease remission and stabilized or even improved renal function in 100 patients at high risk of poor outcomes because of persistent NS pointed to a pathogenic role of antibody-producing lymphocytes in primary MN. 5 Indeed, experimental and human data converge to indicate that deposition along the glomerular basement membrane of immunoglobulins produced by autoreactive B cells initiates the sequence of events, resulting in secondary injury to the glomerular filtering barrier and proteinuria.…”

mentioning

confidence: 99%

Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy

Ruggenenti

Dębiec

Ruggiero

et al. 2015

Journal of the American Society of Nephrology

318

255

View full text Add to dashboard Cite

Rituximab induces nephrotic syndrome (NS) remission in two-thirds of patients with primary membranous nephropathy (MN), even after other treatments have failed. To assess the relationships among treatment effect, circulating nephritogenic anti-phospholipase A 2 receptor (anti-PLA 2 R) autoantibodies and genetic polymorphisms predisposing to antibody production we serially monitored 24-hour proteinuria and antibody titer in patients with primary MN and long-lasting NS consenting to rituximab (375 mg/m 2 ) therapy and genetic analyses. Over a median (range) follow-up of 30.8 (6.0-145.4) months, 84 of 132 rituximabtreated patients achieved complete or partial NS remission (primary end point), and 25 relapsed after remission. Outcomes of patients with or without detectable anti-PLA 2 R antibodies at baseline were similar. Among the 81 patients with antibodies, lower anti-PLA 2 R antibody titer at baseline (P=0.001) and full antibody depletion 6 months post-rituximab (hazard ratio [HR], 7.90; 95% confidence interval [95% CI], 2.54 to 24.60; P,0.001) strongly predicted remission. All 25 complete remissions were preceded by complete anti-PLA 2 R antibody depletion. On average, 50% anti-PLA 2 R titer reduction preceded equivalent proteinuria reduction by 10 months. Re-emergence of circulating antibodies predicted disease relapse (HR, 6.54; 95% CI, 1.57 to 27.40; P=0.01), whereas initial complete remission protected from the event (HR, 6.63; 95% CI, 2.37 to 18.53; P,0.001). Eighteen patients achieved persistent antibody depletion and complete remission and never relapsed. Outcome was independent of PLA2R1 and HLA-DQA1 polymorphisms and of previous immunosuppressive treatment. Therefore, assessing circulating anti-PLA 2 R autoantibodies and proteinuria may help in monitoring disease activity and guiding personalized rituximab therapy in nephrotic patients with primary MN.

show abstract

“…4 -6 This is in part because of the heterogeneity of disease and lack of reliable biomarkers because of ignorance of the target antigens and nephritogenic antibodies. New strategies to target B-lymphocytes with anti-CD20 antibody [7][8][9] and to inhibit complement 10 have been designed but with varying efficacy. The key to a specific pathophysiology-driven therapy is the understanding of initiating factors leading to the development of immune deposits, which first requires identification of the pathogenic antigens and then the ensuing events mediated by C5b-9.…”

mentioning

confidence: 99%

Antigen Identification in Membranous Nephropathy Moves toward Targeted Monitoring and New Therapy

Ronco

Dębiec²

2010

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Successful Treatment of Membranous Glomerulonephritis with Rituximab in Calcineurin Inhibitor-Dependent Patients

Abstract: Conclusions: In patients with MGN with long-term CNI dependence, rituximab can be an effective tool to overcome dependence on CNI, thus avoiding the risk of nephrotoxicity related to the chronic exposure to these drugs.

Cited by 83 publications

References 23 publications

Pharmacological treatment of primary membranous nephropathy in 2016

Pharmacological treatment of primary membranous nephropathy in 2016

Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy

Antigen Identification in Membranous Nephropathy Moves toward Targeted Monitoring and New Therapy

Contact Info

Product

Resources

About