Rituximab in anti-glomerular basement membrane disease.

The role of rituximab has expanded beyond the treatment of non-Hodgkins lymphoma, to include successful management of rheumatoid arthritis, systemic lupus erythematosus, anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis and primary glomerulonephritis. Decrease incidence of side-effects or toxicity, coupled with clinical effectiveness, suggests that B-cell depleting agents may convey an advantage over traditional immunosuppressive agents. Rituximab therapy has previously been reported in anti-glomerular basement membrane (GBM) disease. Because of side-effects such as sterility and the risk of infection in the febrile patient with conventional therapy, we have used rituximab in anti-GBM disease to suppress antibody production. We report three cases of anti-GBM disease treated with rituximab along with steroids and plasma exchange.