Latest treatment strategies for membranous nephropathy.
Thirty to forty percent of patients with idiopathic membranous nephropathy have persistent heavy proteinuria and may progress to end-stage kidney disease in 5 - 15 years. The ideal treatment for these patients is a matter of debate. Several nonspecific immunosuppressive regimens have been suggested with the aim of reducing proteinuria and to improve outcome, but all are burdened by significant toxicity. Therefore, more specific and less toxic therapies are needed. Promising results have been recently obtained with rituximab, a monoclonal antibody against the CD20 antigen of B lymphocytes that is able to deplete these cells and, thus, neoformation of pathogenetic antibodies. Other novel drugs, such as adrenocorticotropic hormone, mycophenolate mofetil and eculizumab have been proposed. This paper reviews the safety/efficacy profile of various agents that have been proposed as therapy for this disease, with particular focus on the latest, more specific and hypothesis-driven approaches.
Ruggenenti
Piero
P
Mario Negri Institute for Pharmacological Research, Department of Renal Medicine, Clinical Research Center for Rare Diseases Aldo E Cele Daccó, Via Gavazzeni 11, 24125 Bergamo, Italy.
Cravedi
Paolo
P
Remuzzi
Giuseppe
G
D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000477:Alkylating Agents / Q000627:therapeutic use; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology; D065095:Calcineurin Inhibitors; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy* / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011507:Proteinuria / Q000188:drug therapy; D000069283:Rituximab
D000477:Alkylating Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000069283:Rituximab; D000324:Adrenocorticotropic Hormone; C481642:eculizumab; D009173:Mycophenolic Acid