Abstrakt
ANCA-associated vasculitides are multisystem disorders that often affect the kidneys with an aggressive inflammation, leaving irreversible damage. The introduction of cyclophosphamide transformed the disease from a fatal to a chronic relapsing one, but an unsatisfactorily high morbidity and mortality remain from treatment side effects and chronic organ dysfunction.
Clinical trials of rituximab, a monoclonal chimeric CD20 antibody, have resulted in an attempt to avoid this toxicity. Upon binding, rituximab induces apoptosis of pre-B and mature B lymphocytes via antibodyand complement-dependent cytotoxicity, and the CD20 antibody established itself as a noninferior induction alternative to cyclophosphamide.
Here, we discuss the use of rituximab in severe ANCAassociated GN, with a focus on the frail and elderly population, highlighting benefits, special requirements, and pitfalls to improve individualized medicine and outcomes in ANCA GN.