Is it the time to offer rituximab as a cost-benefit treatment for immunoglobulin A nephropathy? A short-review to current concepts

Abstract

Context: IgA nephropathy (IgAN) as an autoimmune disease is the most common cause of glomerulonephritis worldwide. Rituximab effectively depletes B cells and reduces serum levels of IgA1 antibodies. This paper aimed to review the potential benefit of rituximab used in clinical practice of IgAN patients. Evidence Acquisitions: PubMed, EBSCO, Web of Science, directory of open access journals (DOAJ), EMBASE, and Google Scholar were searched for the keywords of IgA nephropathy, rituximab, B cell depletion and autoimmune diseases. Results: Rituximab therapy improved in nephropathies and in recurrent IgAN in several studies. The mechanisms of rituximab therapy in IgAN are unknown. However, a direct effect of rituximab on podocytes by cytoskeleton stabilization is possible. Additionally a possible effect of rituximab on B cells in IgAN may lead to its beneficial impact. Conclusions: This short-review demonstrates that rituximab therapy may be an effective treatment option in IgAN patients, particularly for histological signs of active inflammation. However, results of safety and efficacy of rituximab in IgAN are limited, and definitive conclusions will require further studies. Thus, multicenter clinical trials for safety and efficacy of rituximab therapy are necessary.

Keywords

• iga nephropathy
• rituximab
• b cell depletion
• autoimmune diseases