Rituximab in glomerular diseases: Indications, long-term use, complications and research gaps.

Area of Science:

• Nephrology
• Immunology
• Pharmacology

Background:

• Rituximab (RTX) is a CD20-targeting monoclonal antibody used in treating glomerular diseases.
• It is approved for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and used off-label for other conditions.

Purpose of the Study:

• To review RTX indications in glomerular diseases.
• To address potential risks and identify knowledge gaps regarding its use.
• To discuss RTX's continued relevance amidst emerging therapies.

Main Methods:

• Literature review of RTX in glomerular disease management.
• Analysis of current evidence regarding efficacy and safety.
• Identification of areas lacking high-quality clinical trial data.

Main Results:

• RTX is established for ANCA-associated vasculitis but evidence for other glomerular diseases is less robust.
• Optimal dosing and administration schedules remain undetermined.
• Risks include infections, neutropenia, B-cell depletion, hypogammaglobulinemia, and impaired vaccine response.

Conclusions:

• RTX remains a relevant treatment option for glomerular diseases due to cost-effectiveness and physician experience.
• Further research is needed to optimize RTX use and address safety concerns.
• Emerging B-cell therapies may offer alternatives but RTX's role persists.