[An innovative approach to the treatment of immune-mediated glomerular diseases]

Conventional treatment of most glomerular immune-mediated diseases is based mainly on the use of cytotoxic immunosuppressants and corticosteroids. Although this has resulted in improved survival, patients may suffer severe, sometimes life-threatening, adverse events. The increasing need for safer and more effective drugs along with burgeoning new insights into the pathogenesis of these disorders has aroused interest in a variety of biological agents. In this context, clinical trials involving the B-cell depletion agent Rituximab have been especially promising. Rituximab is a monoclonal antibody to the CD20 antigen on B-cells that was initially designed and approved for the treatment of non-Hodgkins B-cell lymphoma in 1997. Over the last 15 years, it has emerged as a potent immunosuppressant for several immune-mediated diseases, initially for the treatment of rheumatoid arthritis , with FDA approval in 2007. Subsequently its use has been extended into several other fields, including the treatment of glomerulonephritis. Recently (April 2011), the FDA approved Rituximab for the treatment of ANCA-associated vasculitis. However, given its efficacy, tolerability and safety profile in comparison to conventional treatment regimens, it has been also studied in off-label use for many other glomerular diseases, including membranous nephropathy, lupus nephritis, and mixed cryoglobulinemia.