Obinutuzumab, an Anti-CD20, in Refractory Adult Autoimmune Podocytopathies: Report of 2 Cases

Autoimmune podocytopathies can represent a therapeutic challenge in the case of frequently relapsing nephrotic syndrome leading to steroid dependence or steroid resistance. Rituximab is an effective treatment option, but allergic reactions or resistance to treatment are frequent. The first case describes a 32-year-old man with corticosteroid-dependent nephrotic syndrome since childhood. After multiple relapses and treatments with cyclosporine, mycophenolate mofetil, and rituximab, a third rituximab treatment led to life-threatening laryngospasm, contraindicating its further use. A treatment with obinutuzumab sustained remission, without additional immunosuppressive treatment, still maintained after 36 months of follow-up. The second case involves a 42-year-old man with nephrotic syndrome, kidney failure, and severe hypertension. A first biopsy showed minimal change disease, whereas a second biopsy found focal segmental glomerulosclerosis lesions. Despite treatments with corticosteroids, cyclosporine, and rituximab, he required hemodialysis. A few years later, he received his first kidney transplant. A relapse was diagnosed at day 3 posttransplantation. Obinutuzumab treatment led to significant improvement in kidney function and sustained remission of the nephrotic syndrome, without relapse 2 years after this treatment. Obinutuzumab could therefore provide a safe and effective alternative to these patients with allergic reactions or resistance to rituximab.