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Successful treatment of PLA(2)R1-antibody positive membranous nephropathy with ocrelizumab

Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. The disease is induced by antibodies, which are directed against the podocyte protein phospholipase A(2) receptor 1 (PLA(2)R1-ab) in 80% of cases. B cell depleting treatments, most notably rituximab, a chimeric CD20-antib...

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Autores principales: Schmidt, Tilman, Schulze, Matthias, Harendza, Sigrid, Hoxha, Elion
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036191/
https://www.ncbi.nlm.nih.gov/pubmed/33026632
http://dx.doi.org/10.1007/s40620-020-00874-2
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author Schmidt, Tilman
Schulze, Matthias
Harendza, Sigrid
Hoxha, Elion
author_facet Schmidt, Tilman
Schulze, Matthias
Harendza, Sigrid
Hoxha, Elion
author_sort Schmidt, Tilman
collection PubMed
description Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. The disease is induced by antibodies, which are directed against the podocyte protein phospholipase A(2) receptor 1 (PLA(2)R1-ab) in 80% of cases. B cell depleting treatments, most notably rituximab, a chimeric CD20-antibody, are often effective for treatment of MN. However, in 35–40% of patients rituximab fails to induce remission of disease and relapses after rituximab-induced remission are frequent. Therefore, alternative treatment options are necessary. Over the past years optimized antibodies targeting CD20 were designed to overcome side effects or sensitization to the murine fractions of rituximab and potentially improve B cell depletion. Ocrelizumab is a humanized B cell depleting antibody, approved for treatment of multiple sclerosis (MS). Here, we report the case of a patient who was diagnosed with MS and, 8 years later, developed PLA(2)R1-associated MN. Treatment for MS was switched to the CD20-antibody ocrelizumab, which was expected to deplete B cells and potentially induce remission of MN. After treatment with ocrelizumab PLA(2)R1-ab disappeared from the circulation and the patient developed remission of proteinuria. Ocrelizumab might be an efficacious treatment alternative for patients with MN who fail to achieve remission or are immunologically sensitized to rituximab. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40620-020-00874-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-80361912021-04-27 Successful treatment of PLA(2)R1-antibody positive membranous nephropathy with ocrelizumab Schmidt, Tilman Schulze, Matthias Harendza, Sigrid Hoxha, Elion J Nephrol Case Report Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. The disease is induced by antibodies, which are directed against the podocyte protein phospholipase A(2) receptor 1 (PLA(2)R1-ab) in 80% of cases. B cell depleting treatments, most notably rituximab, a chimeric CD20-antibody, are often effective for treatment of MN. However, in 35–40% of patients rituximab fails to induce remission of disease and relapses after rituximab-induced remission are frequent. Therefore, alternative treatment options are necessary. Over the past years optimized antibodies targeting CD20 were designed to overcome side effects or sensitization to the murine fractions of rituximab and potentially improve B cell depletion. Ocrelizumab is a humanized B cell depleting antibody, approved for treatment of multiple sclerosis (MS). Here, we report the case of a patient who was diagnosed with MS and, 8 years later, developed PLA(2)R1-associated MN. Treatment for MS was switched to the CD20-antibody ocrelizumab, which was expected to deplete B cells and potentially induce remission of MN. After treatment with ocrelizumab PLA(2)R1-ab disappeared from the circulation and the patient developed remission of proteinuria. Ocrelizumab might be an efficacious treatment alternative for patients with MN who fail to achieve remission or are immunologically sensitized to rituximab. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40620-020-00874-2) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-10-07 2021 /pmc/articles/PMC8036191/ /pubmed/33026632 http://dx.doi.org/10.1007/s40620-020-00874-2 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Report
Schmidt, Tilman
Schulze, Matthias
Harendza, Sigrid
Hoxha, Elion
Successful treatment of PLA(2)R1-antibody positive membranous nephropathy with ocrelizumab
title Successful treatment of PLA(2)R1-antibody positive membranous nephropathy with ocrelizumab
title_full Successful treatment of PLA(2)R1-antibody positive membranous nephropathy with ocrelizumab
title_fullStr Successful treatment of PLA(2)R1-antibody positive membranous nephropathy with ocrelizumab
title_full_unstemmed Successful treatment of PLA(2)R1-antibody positive membranous nephropathy with ocrelizumab
title_short Successful treatment of PLA(2)R1-antibody positive membranous nephropathy with ocrelizumab
title_sort successful treatment of pla(2)r1-antibody positive membranous nephropathy with ocrelizumab
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036191/
https://www.ncbi.nlm.nih.gov/pubmed/33026632
http://dx.doi.org/10.1007/s40620-020-00874-2
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