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Review
. 2020 Nov;19(11):102671.
doi: 10.1016/j.autrev.2020.102671. Epub 2020 Sep 15.

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

Philipp Gauckler  1 , Jae Il Shin  2 , Federico Alberici  3 , Vincent Audard  4 , Annette Bruchfeld  5 , Martin Busch  6 , Chee Kay Cheung  7 , Matija Crnogorac  8 , Elisa Delbarba  9 , Kathrin Eller  10 , Stanislas Faguer  11 , Kresimir Galesic  8 , Siân Griffin  12 , Zdenka Hrušková  13 , Anushya Jeyabalan  14 , Alexandre Karras  15 , Catherine King  16 , Harbir Singh Kohli  17 , Rutger Maas  18 , Gert Mayer  19 , Sergey Moiseev  20 , Masahiro Muto  21 , Balazs Odler  10 , Ruth J Pepper  22 , Luis F Quintana  23 , Jai Radhakrishnan  14 , Raja Ramachandran  17 , Alan D Salama  22 , Mårten Segelmark  24 , Vladimír Tesař  13 , Jack Wetzels  18 , Lisa Willcocks  25 , Martin Windpessl  26 , Ladan Zand  27 , Reza Zonozi  28 , Andreas Kronbichler  29 ; RITERM study group
Affiliations
Free article
Review

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

Philipp Gauckler et al. Autoimmun Rev. 2020 Nov.
Free article

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.

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Conflict of interest statement

Declaration of Competing Interest 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.

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