Experience with new anti-CD20 monoclonal antibodies for immune-mediated glomerulopathies in a tertiary hospital

In the recent years, new humanized anti-CD20 monoclonal antibodies have been developed to optimize B-cell depletion. Our objective is to describe the experience at our center with the use of new anti-CD20 drugs in glomerular diseases. We included patients from our center treated with second-generation anti-CD20 monoclonal antibodies for glomerular diseases between January 2017 and January 2024. Patients were followed for one year after the initiation of treatment. Six patients were included, 2 (33%) men, with a median age of 59.5 (49-75) years. Diagnoses were 2 (33%) minimal change disease, 1 (16.7%) mixed cryoglobulinemia type-II, 1 (16.7%) membranous nephropathy, 1 (16.7%) fibrillary glomerulonephritis (FGN), and 1 (16.7%) focal segmental glomerulosclerosis. The indications for the new anti-CD20 therapy were 4 (66%) for refractory disease, 1 (16.7%) recurrent flares, and 1 (16.7%) due to an anaphylactic reaction to rituximab. The new anti-CD20 used were obinutuzumab in 4 (66%) and ofatumumab in 2 patients (33%). Before the start of the treatment median creatinine was 1.39mg/dL (0.91-2.38) median serum albumin 2.7g/dL [2.5-3.9g/dL] and urine protein-creatinine ratio (UPCR) 5.75g/g [2.38-4.85g/g]. A total of 5 (83%) patients achieved partial/complete remission within the first 6 months of follow-up. By month twelve of the follow-up 4 (66.67%) patients remained with partial/complete remission. None of the patients had serious side effects. In conclusion, the use of new anti-CD20 therapies for the treatment of immune-mediated glomerular diseases is a safe and effective alternative for its treatment. Further research and clinical trials should be conducted to confirm these positive results.