rituximab (Rituxirel / Toritz)

Switching Beyond Rituximab in Primary Glomerular Diseases: A Systematic Review of Within-Patient Efficacy and Safety of Non-Rituximab Anti-CD20 Antibodies.

Martino Francesca K FK, Stefanelli Lucia F LF, Cattarin Leda L, Del Prete Dorella D et al.

Background/Objectives: Rituximab is widely used in primary glomerular diseases, but treatment may fail for several reasons, including primary non-response, incomplete response, relapse, intolerance or anti-rituximab antibodies. We assessed within-patient efficacy and safety after switching to another anti-CD20 antibody, considering the reason for switching. Methods: PubMed and Scopus were searched from inception to 15 May 2026 without language restrictions. Eligible reports included adults with primary glomerular disease treated with a non-rituximab anti-CD20 antibody after rituximab and reporting within-patient outcomes. Risk of bias was assessed with design-specific JBI tools and certainty with GRADE. Heterogeneity precluded meta-analysis, and findings were synthesized narratively. Results: A total of 309 patients were included across 43 studies: 283 had membranous nephropathy (MN), 18 had minimal change disease (MCD), 6 had focal segmental glomerulosclerosis (FSGS), and 2 had IgA nephropathy (IgAN). Obinutuzumab was the principal drug used, and the main reasons for switching were primary non-response, with immunization, relapse, or intolerance occurring less frequently. In MN, among the 262 patients with available response data, 217 achieved complete or partial remission, and relapse was rare. For MCD, 17 of 18 patients with active disease attained remission, and only one relapsed during follow-up. On the other hand, five out of the six FSGS patients responded, but three of them relapsed. The two patients with IgAN achieved either complete or partial remission. Notably, these results may not apply to conventional IgAN, since one biopsy showed contextually MCD and the other was proliferative and crescentic. Infusion-related reactions were the most frequent adverse events and were generally mild, while infections were the main issue during the follow-up. Evidence certainty for all outcomes was very low. Conclusions: Switching to a non-rituximab anti-CD20 antibody may be a feasible rescue strategy, most convincingly after intolerance, rituximab immunization, or relapse. The uncontrolled, very-low-certainty evidence precludes firm recommendations, and controlled studies are warranted.

Treatment of mild to moderate pemphigus with the use of rituximab and topical corticosteroids.

Oualid D D, Lheure C C, Louchez A A, Tancrede-Bohin E E et al.

One trigger, two systems: post-infectious severe Guillain-Barre syndrome with concurrent central nervous system demyelination": a case report.

Numan Mohammad M, Alhatou Mohammad M, Hussain Zaeem Z, Hussain Maidah M et al.

Combined central and peripheral demyelination is a rare but serious neurological condition that is associated with poor outcomes. We report a 31-year-old male presenting with rapidly progressive Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) variant of Guillain-Barré syndrome following an upper respiratory tract infection. The course was complicated by respiratory failure requiring intubation and significant autonomic dysfunction. Despite treatment with intravenous immunoglobulin, there was minimal clinical improvement. Further imaging of the central nervous system revealed multiple acute demyelinating lesions involving the brain and spinal cord. The patient subsequently received plasmapheresis and high-dose intravenous steroids without significant neurological recovery. A severe hospital-acquired infection delayed rituximab initiation until four months after symptom onset; however, neurological recovery remained minimal. This case highlights the rare coexistence of post-infectious central and peripheral demyelination. Early recognition of central involvement in patients with poor response to standard GBS therapy may help guide escalation of immunotherapy and potentially improve outcomes.

CD20-Positive B-Cell Non-Hodgkin Lymphoma Associated With Recurrent Acute Pancreatitis, Bilateral Renal Lesions, and Retroperitoneal Lymphadenopathy.

Sarfraz Rehan R, Ledesma Leon Magnie L ML, Nabi Dunia D, Hernandez Carratala Laura L et al.

Acute pancreatitis is most often caused by gallstones, alcohol use, or hypertriglyceridemia, whereas malignancy is an uncommon association. We report a case of a 29-year-old woman with recurrent acute pancreatitis without a clearly dominant, identifiable cause. Although she reported intermittent heavy weekend alcohol use, recurrence after initial improvement, increasing lactate dehydrogenase (LDH), bilateral renal cortical lesions, and progressive retroperitoneal lymphadenopathy suggested a systemic process. Core biopsy of a retroperitoneal lymph node demonstrated a CD20-positive B-cell non-Hodgkin lymphoma with a Ki-67 proliferation index of up to 80%. Limited tissue and nondiagnostic flow cytometry prevented definitive subclassification; diffuse large B-cell lymphoma (DLBCL) remained in the differential diagnosis. One documented cycle of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was administered during a subsequent hospitalization, with short-term symptomatic, pancreatic enzyme, and renal improvement. The patient was subsequently lost to follow-up. This case emphasizes the importance of considering lymphoproliferative disease when recurrent pancreatitis is accompanied by progressive systemic imaging abnormalities.