title: Anti-CD20 Antibodies for Idiopathic Nephrotic Syndrome in Children.
abstract: Rituximab, a chimeric anti-CD20 monoclonal antibody originally licensed for lymphoma, is emerging as a novel steroid-sparing agent for idiopathic nephrotic syndrome in children. The potential use of anti-CD20 monoclonal antibodies in idiopathic nephrotic syndrome has contributed to shifting the view of podocytopathies from T cell-mediated to more complex immunomediated disorders that can benefit from targeting B cells and other mediators of the early immune response. Clinical data on the use of rituximab also have implications on disease management and classification. In this review, we present results of clinical studies that support rituximab as an effective steroid-sparing agent in steroid-dependent idiopathic nephrotic syndrome. Recent randomized controlled trials suggest that potential benefits of rituximab therapy in steroid-dependent forms of idiopathic nephrotic syndrome vary depending on whether children are dependent on steroids alone or on both steroids and calcineurin inhibitors, with greater probabilities to achieve drug-free remission in the former group. Multiple-drug dependence may identify a different disease state with different prognosis and treatment options. Insufficient data are available on optimal use of rituximab as a maintenance steroid-sparing agent in these steroid-sensitive forms of the disease, including how often and for how long rituximab infusions should be repeated to maximize expected benefits and minimize potential harms. Finally, one randomized controlled trial in children with steroid-resistant idiopathic nephrotic syndrome yielded negative results. New anti-CD20 antibodies are under study in this patient population.
authors.affiliation: Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; and GMarcoGhiggeri@gaslini.org pravani@ucalgary.ca.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.affiliation: Division of Nephrology, Dialysis, Transplantation and.
authors.forename: Alice
authors.initials: A
authors.lastname: Bonanni
authors.affiliation: Division of Nephrology, Dialysis, Transplantation and.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossi
authors.affiliation: Division of Nephrology, Dialysis, Transplantation and.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Caridi
authors.affiliation: Division of Nephrology, Dialysis, Transplantation and Laboratory on Pathophysiology of Uremia, Giannina Gaslini Children's Hospital, Genoa, Italy GMarcoGhiggeri@gaslini.org pravani@ucalgary.ca.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Ghiggeri
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018951:Antigens, CD20 / Q000276:immunology*; D002648:Child; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D000069283:Rituximab / Q000627:therapeutic use*
chemical_list: D000911:Antibodies, Monoclonal; D018951:Antigens, CD20; D007155:Immunologic Factors; D000069283:Rituximab
keywords: T-lymphocytes; anti-CD20 monoclonal antibodies; antibodies; child; glomerular disease; humans; immunosuppressive agents; monoclonal; nephrotic syndrome; proteinuria; rituximab