[Monoclonal antibodies in nephrology: a delicate balance between curative potential, evidence of effectiveness, and toxicity].
Rituximab is a chimeric human-murine anti-CD20 monoclonal antibody able to obtain the depletion of B lymphocytes. In recent         years significant clinical experience has been gained and literature studies have been carried out investigating the possible role of         this drug in autoimmune conditions such as immune-mediated glomerulonephritis and transplant rejection. It must be stressed that at         present the drug is not registered for any type of kidney disease and its use in nephrology is to be considered off-label. A recent         report showed that rituximab is generously administered in clinical settings where the support of the literature is still debated and         inconclusive; in a significant number of cases the drug is used in contexts where the scientific support can be considered substantially inconsistent.         This brief report will address the principal findings on the use of rituximab in nephrology. It will also briefly evaluate the role of eculizumab,         a novel biological drug active on the complement cascade. Experimental evidence points to a central role for these two new drugs in many         immune-mediated conditions of nephrologic interest. This exciting field of research is still in its infancy with regard to the scientific         assessment of the clinical applications. In view of the ethical considerations concerning the toxicity of therapeutic interventions and         the need to give patients the best available treatment, a great collaborative effort is required by the nephrology community to address         these clinical issues in the context of multicenter randomized controlled studies.
Divisione di Nefrologia Dialisi e Trapianto, Dipartimento di Medicina, Medicina d'Urgenza e Specialità Mediche, Azienda Ospedaliero Universitaria di Modena Policlinico, Modena, Italy. riccardo.magistroni@unimore.it
Riccardo
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Magistroni
D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003449:Cryoglobulinemia / Q000188:drug therapy / Q000276:immunology; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000276:immunology; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology; D008181:Lupus Nephritis / Q000188:drug therapy / Q000276:immunology; D009402:Nephrosis, Lipoid / Q000188:drug therapy; D000069283:Rituximab
D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab; C481642:eculizumab