Kidney damage from refractory idiopathic membranous nephropathy may be reduced or even healed with rituximab (Rituxan), researchers here found.
In a small study, 20% of patients with the autoimmune disease achieved complete remission on rituximab, reported Piero Ruggenenti, M.D., of Negri Bergamo Laboratories here, and colleagues in the November issue of the Clinical Journal of the American Society Nephrology.
Repeat kidney biopsies showed that autoantibodies disappeared over time and glomerular structural damage healed, which the researchers said was "likely to translate into long-term renoprotection."
These findings represent a first step toward selective therapy, they wrote.
Membranous nephropathy, one of the most common immune-mediated kidney diseases, involves immunoglobulins produced by B cells, which are the primary target of rituximab.
Treatment for the disease has traditionally relied on steroids and broader spectrum immune suppression with drugs such as alkylating agents, calcineurin inhibitors, and mycophenolate mofetil (CellCept, Myfortic).
However, these immunosuppressant agents carry severe toxicity risk without much benefit for kidney survival, the researchers noted. Despite therapy, 40% of patients progress to end-stage renal failure.