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Aslam Ahsan; Koirala Abbal: Review of the Role of Rituximab in the Management of Adult Minimal Change Disease and Immune-Mediated Focal and Segmental Glomerulosclerosis. Glomerular Diseases Doi.org/10.1159/000533695
It is not presently known if minimal change disease (MCD) and primary focal and segmental glomerulosclerosis (pFSGS) are separate disease entities or part of a continuous spectrum of a single disease. Both are diffuse podocytopathies that have many clinical features in common, but MCD tends to be much more steroid-responsive than pFSGS. Rituximab (RTX) is an emerging therapeutic agent for both disorders, when they are steroid-sensitive, but not when they are steroid-resistant.
Aslam and Koirala provide a comprehensive and current overview of the utility of RTX in MCD/pFSGS. General agreement exists that RTX therapy can diminish the frequency of relapses in both disorders when they are steroid-sensitive and steroid-dependent. Contrariwise, the existing data is not very encouraging for benefits of RTX therapy in steroid-resistant forms of pFSGS or MCD. No convincing data is yet available that supports the use of RTX for therapy of treatment-naïve MCD or pFSGS. Dosing regimens for RTX in steroid-resistant MCD or pFSGS have not yet been adequately explored and the use of second-generation anti-CD20 monoclonal antibodies (Obinutuzumab or Ofatumumab) is largely lacking.
In sum, RTX is a useful addition to the therapeutic toolbox in steroid-sensitive MCD or pFSGS, but this optimism does not apply (yet) to steroid-resistant disease.
