新型免疫抑制剂在特发性膜性肾病治疗中的研究进展

doi:10.3760/cma.j.issn.1007-1245.2023.18.001

摘要/Abstract

摘要：

特发性膜性肾病是成人肾病综合征最常见的原因。传统的免疫抑制剂虽能提高缓解率，但存在严重不良反应，部分患者在数年内可进展为终末期肾病。本文主要介绍新型免疫抑制剂在特发性膜性肾病治疗中的进展。

关键词:

特发性膜性肾病, 新型免疫抑制剂, 利妥昔单抗, 进展

Abstract:

Idiopathic membranous nephropathy is the most common cause of nephrotic syndrome in adults. Although conventional immunosuppressive drugs can improve the remission rate, there are serious adverse effects and some patients can progress to end-stage renal disease within a few years. This article mainly introduces the progress on new immunosuppressive agents in the treatment of idiopathic membranous nephropathy.

Key words:

Idiopathic membranous nephropathy, New immunosuppressive agents, Rituximab, Progress

杨佳席哲帆邹皓珍徐强董华.

新型免疫抑制剂在特发性膜性肾病治疗中的研究进展 [J]. 国际医药卫生导报, 2023, 29(18): 2517-2521.

Yang Jia, Xi Zhefan, Zou Haozhen, Xu Qiang, Dong Hua.

Research progress on new immunosuppressive agents in treatment of idiopathic membranous nephropathy [J]. International Medicine and Health Guidance News, 2023, 29(18): 2517-2521.

参考文献

[1] Ronco P, Beck L, Debiec H, et al. Membranous nephropathy[J]. Nat Rev Dis Primers, 2021,7(1):69. DOI: 10.1038/s41572-021-00303-z.
[2] Cai Q, Hendricks AR. Membranous nephropathy: a ten-year journey of discoveries[J]. Semin Diagn Pathol, 2020,37(3):116-120. DOI: 10.1053/j.semdp.2020.01.001.
[3] Gauckler P, Shin JI, Alberici F, et al. Rituximab in membranous nephropathy[J]. Kidney Int Rep, 2021,6(4):881-893. DOI: 10.1016/j.ekir.2020.12.035.
[4] van den Brand JA, van Dijk PR, Hofstra JM, et al. Long-term outcomes in idiopathic membranous nephropathy using a restrictive treatment strategy[J]. J Am Soc Nephrol, 2014,25(1):150-158. DOI: 10.1681/ASN.2013020185.
[5] Brglez V, Boyer-Suavet S, Seitz-Polski B. Complement pathways in membranous nephropathy: complex and multifactorial[J]. Kidney Int Rep, 2020,5(5):572-574. DOI: 10.1016/j.ekir.2020.02.1033.
[6] Lutz J. Pathophysiology, diagnosis, and treatment of membranous nephropathy[J]. Nephrol Ther, 2021,17S:S1-S10. DOI: 10.1016/j.nephro.2021.03.001.
[7] Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases[J]. Kidney Int, 2021,100(4S):S1-S276. DOI: 10.1016/j.kint.2021.05.021.
[8] van den Brand JAJG, Ruggenenti P, Chianca A, et al. Safety of rituximab compared with steroids and cyclophosphamide for idiopathic membranous nephropathy[J]. J Am Soc Nephrol, 2017,28(9):2729-2737. DOI: 10.1681/ASN.2016091022.
[9] Ponticelli C, Escoli R, Moroni G. Does cyclophosphamide still play a role in glomerular diseases?[J]. Autoimmun Rev, 2018,17(10):1022-1027. DOI: 10.1016/j.autrev.2018.04.007.
[10] Bomback AS, Fervenza FC. Membranous nephropathy: approaches to treatment[J]. Am J Nephrol, 2018,47 Suppl 1:30-42. DOI: 10.1159/000481635.
[11] Tian Z, Li Y, Xie Y, et al. Efficacy and safety of tacrolimus combined with corticosteroids in patients with idiopathic membranous nephropathy: a systematic review and meta-analysis of randomized controlled trials[J]. Int Urol Nephrol, 2022,54(10):2555-2566. DOI: 10.1007/s11255-022-03169-6.
[12] Salvadori M, Tsalouchos A. New antigens involved in membranous nephropathy beyond phospholipase A2 receptor[J]. World J Nephrol, 2022,11(4):115-126. DOI: 10.5527/wjn.v11.i4.115.
[13] Del Vecchio L, Allinovi M, Rocco P, et al. Rituximab therapy for adults with nephrotic syndromes: standard schedules or B cell-targeted therapy?[J]. J Clin Med, 2021,10(24):5847. DOI: 10.3390/jcm10245847.
[14] Dahan K, Debiec H, Plaisier E, et al. Rituximab for severe membranous nephropathy: a 6-month trial with extended follow-up[J]. J Am Soc Nephrol, 2017,28(1):348-358. DOI: 10.1681/ASN.2016040449.
[15] 韩蜜,潘勇,伍奕.抗肿瘤药物医嘱审核及不合理情况分析[J].临床合理用药杂志,2020,13(17):11-12,17.DOI:10.15887/j.cnki.13-1389/r.2020.17.006.
[16] Fernández-Juárez G, Rojas-Rivera J, Logt AV, et al. The STARMEN trial indicates that alternating treatment with corticosteroids and cyclophosphamide is superior to sequential treatment with tacrolimus and rituximab in primary membranous nephropathy[J]. Kidney Int, 2021, 99(4):986-998. DOI: 10.1016/j.kint.2020.10.014.
[17] Scolari F, Delbarba E, Santoro D, et al. Rituximab or cyclophosphamide in the treatment of membranous nephropathy: the RI-CYCLO randomized trial[J]. J Am Soc Nephrol, 2021,32(4):972-982. DOI: 10.1681/ASN.2020071091.
[18] Kidoguchi K, Kubota Y, Kusaba K, et al. Severe infusion reaction, anti-rituximab antibodies and lymphoma[J]. QJM, 2020,113(4):273-274. DOI: 10.1093/qjmed/hcz296.
[19] Huang L, Dong QR, Zhao YJ, et al. Rituximab for the management of idiopathic membranous nephropathy: a meta-analysis[J]. Int Urol Nephrol, 2021,53(1):111-119. DOI: 10.1007/s11255-020-02633-5.
[20] Ruggenenti P, Cravedi P, Chianca A, et al. Rituximab in idiopathic membranous nephropathy[J]. J Am Soc Nephrol, 2012,;23(8):1416-1425. DOI: 10.1681/ASN.2012020181.
[21] Teisseyre M, Cremoni M, Boyer-Suavet S, et al. Advances in the management of primary membranous nephropathy and rituximab-refractory membranous nephropathy[J]. Front Immunol, 2022,13:859419. DOI: 10.3389/fimmu.2022.859419.
[22] Casan JML, Wong J, Northcott MJ, et al. Anti-CD20 monoclonal antibodies: reviewing a revolution[J]. Hum Vaccin Immunother, 2018,14(12):2820-2841. DOI: 10.1080/21645515.2018.1508624.
[23] Podestà MA, Ruggiero B, Remuzzi G, et al. Ofatumumab for multirelapsing membranous nephropathy complicated by rituximab-induced serum-sickness[J]. BMJ Case Rep, 2020,13(1):e232896. DOI: 10.1136/bcr-2019-232896.
[24] Podestà MA, Gennarini A, Portalupi V, et al. Accelerating the depletion of circulating anti-phospholipase A2 receptor antibodies in patients with severe membranous nephropathy: preliminary findings with double filtration plasmapheresis and ofatumumab[J]. Nephron, 2020,144(1):30-35. DOI: 10.1159/000501858.
[25] Boyer-Suavet S, Andreani M, Lateb M, et al. Neutralizing anti-rituximab antibodies and relapse in membranous nephropathy treated with rituximab[J]. Front Immunol, 2020,10:3069. DOI: 10.3389/fimmu.2019.03069.
[26] Pierpont TM, Limper CB, Richards KL. Past, Present, and future of rituximab-the world's first oncology monoclonal antibody therapy[J]. Front Oncol, 2018,8:163. DOI: 10.3389/fonc.2018.00163.
[27] Klomjit N, Fervenza FC, Zand L. Successful treatment of patients with refractory pla2r-associated membranous nephropathy with obinutuzumab: a report of 3 cases[J]. Am J Kidney Dis, 2020,76(6):883-888. DOI: 10.1053/j.ajkd.2020.02.444.
[28] Sethi S, Kumar S, Lim K, et al. Obinutuzumab is effective for the treatment of refractory membranous nephropathy[J]. Kidney Int Rep. 2020 Jul 3;5(9):1515-1518. DOI: 10.1016/j.ekir.2020.06.030.
[29] Baert L, Manfroi B, Casez O, et al. The role of APRIL - a proliferation inducing ligand - in autoimmune diseases and expectations from its targeting[J]. J Autoimmun, 2018,95:179-190. DOI: 10.1016/j.jaut.2018.10.016.
[30] Dörner T, Kinnman N, Tak PP. Targeting B cells in immune-mediated inflammatory disease: a comprehensive review of mechanisms of action and identification of biomarkers[J]. Pharmacol Ther, 2010,125(3):464-475. DOI: 10.1016/j.pharmthera. 2010.01.001.
[31] Shabgah AG, Shariati-Sarabi Z, Tavakkol-Afshari J, et al. The role of BAFF and APRIL in rheumatoid arthritis[J]. J Cell Physiol, 2019,234(10):17050-17063. DOI: 10.1002/jcp.28445.
[32] 杨佳,高洁,赵文静,等.泰它西普在IgA肾病和狼疮性肾炎中的研究进展[J].中国现代医学杂志,2022,32(19):51-56.DOI:10.3969/j.issn.1005-8982.2022.19.009.
[33] Jackson SW, Davidson A. BAFF inhibition in SLE-Is tolerance restored?[J]. Immunol Rev, 2019,292(1):102-119. DOI: 10.1111/imr.12810.
[34] Angioi A, Lepori N, López AC, et al. Treatment of primary membranous nephropathy: where are we now?[J]. J Nephrol, 2018,31(4):489-502. DOI: 10.1007/s40620- 017-0427-5.
[35] Barrett C, Willcocks LC, Jones RB, et al. Effect of belimumab on proteinuria and anti-phospholipase A2 receptor autoantibody in primary membranous nephropathy[J]. Nephrol Dial Transplant, 2020,35(4):599-606. DOI: 10.1093/ndt/gfz086.
[36] Netti GS, Infante B, Spadaccino F, et al. Serum levels of BAFF and APRIL predict clinical response in anti-PLA2R-positive primary membranous nephropathy[J]. J Immunol Res, 2019,2019:8483650. DOI: 10.1155/2019/8483650.
[37] van de Donk NWCJ, Usmani SZ. CD38 antibodies in multiple myeloma: mechanisms of action and modes of resistance[J]. Front Immunol, 2018,9:2134. DOI: 10.3389/fimmu.2018.02134.
[38] Vink CH, van Cranenbroek B, van der Heijden JW, et al. Daratumumab for multidrug-resistant phospholipase-A2 receptor-related membranous nephropathy[J]. Kidney Int, 2022,101(3):646-647. DOI: 10.1016/j.kint.2021. 12.019.
[39] 齐焰,贾俊亚,顾秋华,等.低剂量利妥昔单抗对原发性膜性肾病的长期疗效观察[J].中华医学杂志,2022,102(40):3201-3206.DOI:10.3760/cma.j.cn112137-20220716- 01555.
[40] Chen W, Liu Q, Liao Y, et al. Outcomes of tacrolimus therapy in adults with refractory membranous nephrotic syndrome: a prospective, multicenter clinical trial[J]. Am J Med Sci, 2013,345(2):81-87. DOI: 10.1097/MAJ.0b013e31824ce676.
[41] Lateb M, Ouahmi H, Payré C, et al. Anti-PLA2R1 antibodies containing sera induce in vitro cytotoxicity mediated by complement activation[J]. J Immunol Res, 2019,2019:1324804. DOI: 10.1155/2019/1324804.
[42] Gao S, Cui Z, Zhao MH. Complement C3a and C3a receptor activation mediates podocyte injuries in the mechanism of primary membranous nephropathy[J]. J Am Soc Nephrol, 2022,33(9):1742-1756. DOI: 10.1681/ASN.2021101384.
[43] Perry DK, Burns JM, Pollinger HS, et al. Proteasome inhibition causes apoptosis of normal human plasma cells preventing alloantibody production[J]. Am J Transplant, 2009,9(1):201-209. DOI: 10.1111/j.1600-6143. 2008.02461.x.
[44] Salhi S, Ribes D, Colombat M, et al. Bortezomib plus dexamethasone for rituximab-resistant PLA2R+ membranous nephropathy[J]. Kidney Int, 2021,100(3):708-709. DOI: 10.1016/j.kint.2021.04.011.
[45] Hartono C, Chung M, Kuo SF, et al. Bortezomib therapy for nephrotic syndrome due to idiopathic membranous nephropathy[J]. J Nephrol, 2014,27(1):103-106. DOI: 10.1007/s40620-013-0028-x.