Obinutuzumab for Rituximab-Intolerant Minimal Change Disease: A Case Report and Review of Recent Literature

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

B lymphocytes play a central role in the pathogenesis of minimal change disease (MCD). Rituximab is a chimeric (murine-human) type I anti-CD20 monoclonal antibody that depletes B cells and is used in the management of frequently relapsing (FR) and steroid-dependent (SD) MCD. However, continued treatment with rituximab is not feasible in some patients because of severe infusion reactions or hypersensitivity. Obinutuzumab is a humanized type II anti-CD20 monoclonal antibody that produces potent B-cell depletion and has been used as an alternative B-cell-depleting therapy in selected immune-mediated diseases. Experience with its use in adults with FR/SD MCD remains limited. The author reports an adult patient with MCD who developed an immediate hypersensitivity reaction to rituximab, confirmed by positive skin testing, which precluded further treatment. The patient subsequently received obinutuzumab without adverse reactions and achieved clinical remission. To the author's knowledge, this represents one of the first reported cases of successful obinutuzumab treatment following confirmed rituximab allergy in an adult with MCD. Although based on a single case, this report suggests that obinutuzumab may represent a potential therapeutic alternative for selected patients with MCD who are unable to receive rituximab because of hypersensitivity. The current literature on the use of obinutuzumab in adult MCD is also reviewed.