利妥昔单抗单药或联合其他药物治疗膜性肾病的研究进展

    Therapeutic advances of rituximab alone or plus other drugs for membranous nephropathy

    • 摘要: 膜性肾病(membranous nephropathy,MN)是成人肾病综合征常见的病理类型之一,按病因分为特发性膜性肾病(idiopathic membranous nephropathy,IMN)和继发性MN。IMN约占MN发病人群的80%,治疗多采用糖皮质激素联合烷化剂或钙调神经磷酸酶抑制剂(calcineurin inhibitors,CNIs),但烷化剂的致癌风险及CNIs应用后的疾病高复发等缺点,使得这两类药物的应用受到限制。在MN的致病机制中,B细胞作为抗原呈递细胞起着重要作用。新型免疫抑制剂利妥昔单抗(rituximab,RTX)是一种特异性针对B细胞表面抗原CD20的单克隆抗体,在国内外多项临床研究中,RTX单药或联合其他药物治疗MN均获肯定的疗效。单药与联合给药,哪一种治疗方案使得患者获益更多,目前尚无定论。

       

      Abstract: Membranous nephropathy (MN) is a common pathological type of adult nephrotic syndrome. According to the etiology, MN is divided into idiopathic membranous nephropathy (IMN) and secondary membranous nephropathy (SMN). IMN accounts for around 80% of MN patients. Glucocorticoid plus alkylating agents or calcineurin inhibitors (CNIs) are frequently prescribed. However, carcinogenic risk of alkylating agents and a high recurrence of disease after the dosing of CNIs have limited the applications of these two types of drugs. In the pathogenesis of MN, B cells play an important role of acting as antigen presenting cells. Rituximab (RTX), a novel immunosuppressive agent, is a monoclonal antibody specific to B cell surface antigen CD20. In many recent clinical studies, RTX alone or plus other drugs has demonstrated a definite efficacy for MN. Whether or not patients benefit more from a single drug or a combination therapy is yet to be determined.

       

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