Use of rituximab in paediatric nephrology

Abstract

Rituximab is a chimeric monoclonal antibody capable of depleting B cell populations by targeting the CD20 antigen expressed on the cell surface. Its use in oncology, initially in B cell lymphoma and post-transplant lymphoproliferative disorders, predates its current utility in various fields of medicine wherein it has become one of the safest and most effective antibody-based therapies. It was subsequently found to be effective for rheumatological conditions such as rheumatoid arthritis and antineutrophil cytoplasmic antibody-associated vasculitis. Over the past decade, rituximab has generated a lot of interest in nephrology and has become an emerging or accepted therapy for multiple renal conditions, including systemic lupus erythematosus, lupus nephritis, vasculitis, nephrotic syndrome and in different scenarios before and after kidney transplantation. This review outlines its current use in paediatric nephrology practice, focusing on the knowledge required for general paediatricians who may be caring for children prescribed this medication and reviewing them on a shared care basis.

Rituximab as induction therapy in pediatric kidney transplantation: A single‐center experience in four patients

“…The RTX dosing (375 mg/m 2 ) was based on what is described in other indications 3 . It was used as induction therapy with one pulse of steroids (1 g/1.73 m 2 ).…”

“…Thymoglobulins are usually considered in case of iterative transplantations or in highly sensitized patients 7 . RTX is another option and has been described in a few situations 3,8 …”

“…In pediatric nephrology, RTX is used in steroid‐resistant nephrotic syndrome (SRNS), and to a lesser extent in ANCA‐associated vasculitis and membranous nephropathy 2 . In the context of kidney transplantation, RTX can be proposed in several situations, such as EBV‐induced post‐transplant lymphoproliferative disease (PTLD), ABO‐incompatible living‐donor transplantation, or in case of HLA‐sensitized recipients with antibody‐mediated rejection (AMR) 3,4 . However, little is known on its effectiveness and value as induction therapy in (pediatric) renal transplantation, notably in case of pretransplantation EBV replication.…”

“…in case of HLA-sensitized recipients with antibody-mediated rejection (AMR). 3,4 However, little is known on its effectiveness and value as induction therapy in (pediatric) renal transplantation, notably in case of pretransplantation EBV replication. Herein, we present a single-center experience of the use of RTX in four children in this situation.…”

Individualized medication based on pharmacogenomics and treatment progress in children with IgAV nephritis

“…A clinical study on IgA nephropathy (IgAN) patients conducted by Richard et al (Lafayette et al, 2017) yielded different results, with RTX treatment failing to significantly reduce proteinuria or improve renal function in IgAN patients during the period studied. When RTX was used for renal disease, the older the patient was used, the better the outcome, such as the lower risk of relapse, longer B-cell recovery, and lower risk of hypogammaglobulinemia; however, these associations have not been universally confirmed (Sinha et al, 2021). Overall, RTX is a potential therapeutic agent for severe childhood IgAV nephritis where conventional interventions have failed.…”