Obinutuzumab May Be an Effective and Safe Option for Adult Minimal Change Disease and Focal Segmental Glomerulosclerosis Patients after Multitarget Therapy Including Rituximab.
In a retrospective case series of 11 adults with minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) who had relapsed or failed multitarget therapy including rituximab, obinutuzumab induced and largely maintained remission with mostly mild adverse events.
Background
Rituximab is effective and safe for many adults with frequently relapsing or steroid-dependent nephrotic syndrome due to MCD or FSGS, but a subset relapse over short durations or fail to remit despite B-cell depletion. Obinutuzumab, a novel type II anti-CD20 monoclonal antibody, produces deeper and more sustained B-cell depletion than rituximab, making it a candidate for these refractory cases.
Study design
This was a single-center retrospective case series of 11 adult patients (median age 26 years, 81.9% male) with MCD or FSGS who presented with short-duration relapses or lack of remission after multitarget therapy including rituximab. Patients received an average obinutuzumab dose of 2.0 g and were followed for a median of 17 months, with outcomes including first relapse-free time, relapse rate, and subsequent immunosuppressant use.
Key findings
The first relapse-free time was 12.1 months. Two patients with FSGS relapsed, while the remaining patients maintained remission by the end of follow-up. Six patients (54.5%) achieved cessation of corticosteroids and immunosuppressants within 3 months of obinutuzumab, and adverse events were mostly mild.
Clinical implications
Obinutuzumab may be an effective and safe option for inducing remission in adult MCD and FSGS patients who relapse rapidly or fail to remit after multitarget therapy including rituximab. It appeared effective at maintaining remission in MCD, whereas its durability in FSGS remained uncertain given the relapses observed.
Category
Research
Source
Am J Nephrol
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