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Rituximab use in adult primary glomerulopathy: where is the evidence?

Authors Mallat SG, Itani HS, Abou-Mrad RM, Abou Arkoub R, Tanios BY

Received 4 June 2016

Accepted for publication 14 July 2016

Published 29 August 2016 Volume 2016:12 Pages 1317—1327

DOI https://doi.org/10.2147/TCRM.S114316

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh

Samir G Mallat,1 Houssam S Itani,2 Rana M Abou-Mrad,3 Rima Abou Arkoub,4 Bassem Y Tanios1

1Division of Nephrology, Department of Internal Medicine, American University of Beirut Medical Center, 2Division of Nephrology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon; 3Specialist Nephrology, FMC, Abu Dhabi, UAE; 4Division of Nephrology, The Ottawa Hospital, Ottawa, ON, Canada


Abstract: Rituximab is a chimeric anti-CD20 antibody that results in depletion of B-cell lymphocytes. It is currently used in the treatment of a variety of autoimmune diseases, in addition to CD20-positive lymphomas. The use of rituximab in the treatment of the adult primary glomerular diseases has emerged recently, although not yet established as first-line therapy in international guidelines. In patients with steroid-dependent minimal change disease or frequently relapsing disease, and in patients with idiopathic membranous nephropathy (IMN), several retrospective and prospective studies support the use of rituximab to induce remission, whereas in idiopathic focal and segmental glomerulosclerosis (FSGS), the use of rituximab has resulted in variable results. Evidence is still lacking for the use of rituximab in patients with immunoglobulin A nephropathy (IgAN) and idiopathic membranoproliferative glomerulonephritis (MPGN), as only few reports used rituximab in these two entities. Randomized controlled trials (RCTs) are warranted and clearly needed to establish the definitive role of rituximab in the management of steroid-dependent and frequently relapsing minimal change disease, IMN, both as first-line and second-line treatment, and in MPGN. We await the results of an ongoing RCT of rituximab use in IgAN. Although current evidence for the use of rituximab in patients with idiopathic FSGS is poor, more RCTs are needed to clarify its role, if any, in the management of steroid-resistant or steroid-dependent FSGS.

Keywords:
rituximab therapy, primary glomerulopathy, adult glomerunephritis, membranous nephropathy, minimal change disease, focal and segmental glomerulosclerosis, immunoglobulin A nephropathy, idiopathic membranoproliferative glomerulonephritis

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