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Rituximab for immunologic renal disease: What the nephrologist needs to know.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Kronbichler, Andreas  ORCID logo  https://orcid.org/0000-0002-2945-2946
Windpessl, Martin 
Pieringer, Herwig 
Jayne, David RW 

Abstract

Rituximab (RTX), a chimeric, monoclonal anti-CD20 antibody, is increasingly used in immune-mediated renal diseases. While licensed in the induction treatment of ANCA-associated vasculitis, it represents one of the most commonly prescribed off-label drugs. Much of the information regarding its safety has been drawn from experience in hematology and rheumatology. Ample evidence illustrates the safety of RTX, however, rare but serious adverse events have emerged that include progressive multifocal leucoencephalopathy and hepatitis B reactivation. Moderate to severe hypogammaglobulinemia and late-onset neutropenia following RTX therapy confer an increased infectious risk and factors predicting these side effects (i.e. a genetic basis) need to be identified. Nephrologists initiating RTX need to bear in mind that long-term risks and optimal dosing for many renal indications remain unclear. Special considerations must be given when RTX is used in women of childbearing age. We summarize practical aspects concerning the use of RTX. This review will provide nephrologists with information to guide their use of RTX alerting them to safety risks and the need for patient counselling.

Description

Keywords

B-cell depletion, CD20, Infections, Nephrology, Renal diseases, Rituximab, Side effects, Humans, Immune System Diseases, Immunologic Factors, Kidney Diseases, Rituximab

Journal Title

Autoimmun Rev

Conference Name

Journal ISSN

1568-9972
1873-0183

Volume Title

16

Publisher

Elsevier BV