Rituximab in adult minimal change disease and focal segmental glomerulosclerosis - What is known and what is still unknown?

for the RITERM study group

doi:10.1016/j.autrev.2020.102671

Rituximab in adult minimal change disease and focal segmental glomerulosclerosis - What is known and what is still unknown?

for the RITERM study group

Medicine - Renal and Hypertension Division

Research output: Contribution to journal › Review article › peer-review

21 Scopus citations

Abstract

Primary forms of minimal change disease and focal segmental glomerulosclerosis are rare podocytopathies and clinically characterized by nephrotic syndrome. Glucocorticoids are the cornerstone of the initial immunosuppressive treatment in these two entities. Especially among adults with minimal change disease or focal segmental glomerulosclerosis, relapses, steroid dependence or resistance are common and necessitate re-initiation of steroids and other immunosuppressants. Effective steroid-sparing therapies and introduction of less toxic immunosuppressive agents are urgently needed to reduce undesirable side effects, in particular for patients whose disease course is complex. Rituximab, a B cell depleting monoclonal antibody, is increasingly used off-label in these circumstances, despite a low level of evidence for adult patients. Hence, critical questions concerning drug-safety, long-term efficacy and the optimal regimen for rituximab-treatment remain unanswered. Evidence in the form of large, multicenter studies and randomized controlled trials are urgently needed to overcome these limitations.

Original language	English (US)
Article number	102671
Journal	Autoimmunity Reviews
Volume	19
Issue number	11
DOIs	https://doi.org/10.1016/j.autrev.2020.102671
State	Published - Nov 2020

Bibliographical note

Funding Information:
VA reports grants from ADDMEDICA , outside the submitted work; AB reports consulting fees from Chemocentryx, from Merck/MSD and from Astra Zeneca, outside the submitted work; MB reports lecture fees from Boehringer Ingelheim , from Bristol-Myers Squibb , from Novartis, travel support from Hexal, lecture fees and travel support from Vifor Fresenius and lecture fee from Servier, outside the submitted work; CKC reports grants from GlaxoSmithKline, grants and consultancy fees from Retrophin, outside the submitted work; SF reports lecture fees from VIFOR Pharma , outside the submitted work; CK reports being funded by National Institute for Health Research (NIHR) as academic clinical fellow (ACF), during the conduct of the study. All the other authors declared no competing interests.

Publisher Copyright:
© 2020 The Author(s)

Keywords

Focal segmental glomerulosclerosis
Infections
Long-term remission
Minimal change disease
Nephrotic syndrome
Rituximab

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10.1016/j.autrev.2020.102671

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@article{d3733b83a2d24de38fe0bd01f74a0ca1,

title = "Rituximab in adult minimal change disease and focal segmental glomerulosclerosis - What is known and what is still unknown?",

abstract = "Primary forms of minimal change disease and focal segmental glomerulosclerosis are rare podocytopathies and clinically characterized by nephrotic syndrome. Glucocorticoids are the cornerstone of the initial immunosuppressive treatment in these two entities. Especially among adults with minimal change disease or focal segmental glomerulosclerosis, relapses, steroid dependence or resistance are common and necessitate re-initiation of steroids and other immunosuppressants. Effective steroid-sparing therapies and introduction of less toxic immunosuppressive agents are urgently needed to reduce undesirable side effects, in particular for patients whose disease course is complex. Rituximab, a B cell depleting monoclonal antibody, is increasingly used off-label in these circumstances, despite a low level of evidence for adult patients. Hence, critical questions concerning drug-safety, long-term efficacy and the optimal regimen for rituximab-treatment remain unanswered. Evidence in the form of large, multicenter studies and randomized controlled trials are urgently needed to overcome these limitations.",

keywords = "Focal segmental glomerulosclerosis, Infections, Long-term remission, Minimal change disease, Nephrotic syndrome, Rituximab",

author = "{for the RITERM study group} and Philipp Gauckler and Shin, {Jae Il} and Federico Alberici and Vincent Audard and Annette Bruchfeld and Martin Busch and Cheung, {Chee Kay} and Matija Crnogorac and Elisa Delbarba and Kathrin Eller and Stanislas Faguer and Kresimir Galesic and Si{\^a}n Griffin and Zdenka Hru{\v s}kov{\'a} and Anushya Jeyabalan and Alexandre Karras and Catherine King and Kohli, {Harbir Singh} and Rutger Maas and Gert Mayer and Sergey Moiseev and Masahiro Muto and Balazs Odler and Pepper, {Ruth J.} and Quintana, {Luis F.} and Jai Radhakrishnan and Raja Ramachandran and Salama, {Alan D.} and M{\aa}rten Segelmark and Vladim{\'i}r Tesa{\v r} and Jack Wetzels and Lisa Willcocks and Martin Windpessl and Ladan Zand and Reza Zonozi and Andreas Kronbichler",

note = "Funding Information: VA reports grants from ADDMEDICA , outside the submitted work; AB reports consulting fees from Chemocentryx, from Merck/MSD and from Astra Zeneca, outside the submitted work; MB reports lecture fees from Boehringer Ingelheim , from Bristol-Myers Squibb , from Novartis, travel support from Hexal, lecture fees and travel support from Vifor Fresenius and lecture fee from Servier, outside the submitted work; CKC reports grants from GlaxoSmithKline, grants and consultancy fees from Retrophin, outside the submitted work; SF reports lecture fees from VIFOR Pharma , outside the submitted work; CK reports being funded by National Institute for Health Research (NIHR) as academic clinical fellow (ACF), during the conduct of the study. All the other authors declared no competing interests. Publisher Copyright: {\textcopyright} 2020 The Author(s)",

year = "2020",

month = nov,

doi = "10.1016/j.autrev.2020.102671",

language = "English (US)",

volume = "19",

journal = "Autoimmunity Reviews",

issn = "1568-9972",