What is the role of rituximab in treatment of glomerulonephritis?
Jürgen Floege: Rituximab is now a therapy that is very actively researched. It certainly has a role in autoimmune diseases like membranous glomerulonephritis but we are still a little uncertain whether it is better than existing therapies, like cyclophosphamide or calcineurin inhibitors, and the formal trials are still going on. There seems to be an emerging role in minimal change [disease] and focal sclerosis where patients that were resistant to corticosteroids have now been successfully treated with rituximab. In other diseases, we are less certain. There is a very recent study in IgA nephropathy where it was not effective, which is very much in line with our own large trials showing that supportive therapy, blood pressure control, etc, are the key measures in IgA nephropathy and not immunosuppression.
It is clearly not the universal answer; it is a very expensive answer still, and we still need to find out where it is better than existing, relatively cheap and easier therapies and whether it is safer. There is a lot of open questions still with rituximab.