Rituximab

IPNA clinical practice guidelines designate rituximab as a second-line B-cell depletion therapy for nephrotic syndrome. Ofatumumab, a fully humanised anti-CD20 antibody with higher CD20 affinity, showed no superiority over rituximab in a recent RCT. Survival did not differ significantly by rituximab receipt, although the p value approached significance. Rituximab is a chimeric anti-CD20 antibody that was first reported to induce sustained remission in a nephrotic syndrome patient in 2004. B-cell recovery after rituximab therapy strongly correlates with relapse in nephrotic syndrome. Some patients did not receive rituximab because of cost and limited drug availability. Most nephrotic syndrome patients treated with rituximab relapse within 2 years. Re-dosing with rituximab risks development of anti-drug antibodies, which are associated with treatment failure and intolerance. Rituximab exposure was associated with higher treatment abandonment. Only 23.6% of patients underwent immunohistochemistry, and 25 of those patients received rituximab primarily for CD20-positive disease. Rituximab-containing regimens were administered to 35.3% of patients.