Rituximab Dosing in Glomerular Diseases: A Scoping Review

Area of Science:

• Nephrology
• Immunology
• Pharmacology

Background:

• Rituximab is increasingly used for glomerular diseases.
• Current clinical guidelines lack specific rituximab dosing recommendations.
• Evidence-based dosing is crucial for optimizing treatment outcomes.

Purpose of the Study:

• To conduct a scoping review of evidence for rituximab dosing in glomerular diseases.
• To summarize studied rituximab regimens for conditions like ANCA-associated vasculitis, membranous nephropathy, lupus nephritis, and podocytopathies.

Main Methods:

• A comprehensive literature search was performed using the PubMed database.
• Included randomized controlled trials (RCTs) and prospective cohort studies (PCSs).
• Studies focused on efficacy and safety of rituximab in specific glomerular diseases.

Main Results:

• Sixteen distinct rituximab dosing regimens were identified across five glomerular diseases.
• The most common induction regimens were 1000 mg (2 doses) and 375 mg/m² (4 doses/week).
• Rituximab was used as monotherapy or in combination with corticosteroids and other immunosuppressants.

Conclusions:

• Optimal rituximab therapy may involve adapting treatment to achieve B-cell depletion and monitoring biomarkers.
• Rituximab offers potential for steroid minimization or avoidance in glomerular disease management.
• Further research may refine dosing strategies for specific patient populations and disease subtypes.