Experience with new anti-CD20 monoclonal antibodies for immune-mediated glomerulopathies in a tertiary hospital

In the recent years, new humanized anti-CD20 monoclonal antibodies have been developed to optimize B-cell depletion. Our objective is to describe the experience at our center with the use of new anti-CD20 drugs in glomerular diseases. We included patients from our center treated with second-generation anti-CD20 monoclonal antibodies for glomerular diseases between January 2017 and January 2024. Patients were followed for one year after the initiation of treatment. Six patients were included, 2(33%) men, with a mean age of 59.5 (49–75) years. Diagnoses were 2 (33%) minimal change disease, 1 (16.7%) mixed cryoglobulinemia type-II, 1 (16.7%) membranous nephropathy, 1 (16.7%) fibrillary glomerulonephritis (FGN), and 1 (16.7%) focal segmental glomerulosclerosis. The indications for the new anti-CD20 therapy were 4 (66%) for refractory disease, 1 (16.7%) recurrent flares, and 1 (16.7%) due to an anaphylactic reaction to rituximab. The new anti-CD20 used were obinutuzumab in 4 (66%) and ofatumumab in 2 patients (33%). Before the start of the treatment mean creatinine was 1.39mg/dL (0.91-2.38) median serum albumin 2.7g/dL [2.5–3.9g/dL] and urine protein-creatinine ratio (UPCR) 5.75g/g [2.38–4.85g/g]. A total of 5 (83%) patients achieved partial/complete remission within the first 6 months of follow-up. By month twelve of the follow-up 4(66.67%) patients remained with partial/complete remission. None of the patients had serious side effects. In conclusion, the use of new anti-CD20 therapies for the treatment of immune-mediated glomerular diseases is a safe and effective alternative for its treatment. Further research and clinical trials should be conducted to confirm these positive results. En los últimos años, se han desarrollado nuevos anticuerpos monoclonales anti-CD20 humanizados para optimizar la depleción de células B. Nuestro objetivo es describir la experiencia en nuestro centro con el uso de nuevos fármacos anti-CD20 en enfermedades glomerulares. Incluimos pacientes de nuestro centro tratados con anti-CD20 de segunda generación para enfermedades glomerulares entre enero de 2017 y enero de 2024. Los pacientes fueron seguidos durante un año. Se incluyeron seis pacientes, 2(33%) hombres, edad media 59.5(49–75) años. Los diagnósticos fueron: 2(33%) enfermedad de cambios mínimos, 1(16.7%) c crioglobulinemia mixta tipo II, 1(16.7%) nefropatía membranosa, 1(16.7%) glomerulonefritis fibrilar (GNF) y 1(16.7%) glomeruloesclerosis segmentaria y focal. Las indicaciones para la nueva terapia anti-CD20 fueron 4(66%) enfermedad refractaria, 1 (16.7%) recurrencias frecuentes, y 1 (16.7%) reacción anafiláctica a rituximab. Los nuevos anti-CD20 utilizados fueron obinutuzumab en 4 (66%) y ofatumumab en 2 pacientes (33%). Antes del inicio del tratamiento, creatinina media 1.39 mg/dL (0.91–2.38), albúmina sérica mediana 2.7 g/dL [2.5–3.9 g/dL] y cociente proteína/creatinina urinaria 5.75 g/g [2.38–4.85 g/g]. Un total de 5 (83%) pacientes lograron remisión parcial/completa dentro de los primeros 6 meses de seguimiento. A los doce meses, 4 (66.67%) pacientes se mantenían en remisión parcial/completa. Ninguno de los pacientes presentó efectos adversos graves. En conclusión, el uso de nuevas terapias anti-CD20 para el tratamiento de enfermedades glomerulares inmunomediadas es una alternativa segura y eficaz. Se deben realizar más investigaciones y ensayos clínicos para confirmar estos resultados positivos.