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Background <p>The use of immunosuppressive therapies has significantly improved the prognosis of immune-mediated kidney diseases; however, the use of nonspecific therapies, such as cyclophosphamide or bortezomib has so far been limited by substantial toxicity and off-label use. The development of targeted B&#xa0;cell antibodies enables selective interventions in the pathomechanisms with reduced toxicity.</p> Objective <p>To provide an overview of current B&#xa0;cell-targeted therapies in nephrology.</p> Material and methods <p>Evaluation of case series and reports as well as randomized and controlled trials. Review and discussion of guidelines and research into new approvals by the European Medicines Agency (EMA).</p> Results <p>Many B cell therapies are already being used in clinical practice, often off-label due to the lack of controlled trials; however, promising results from phase&#xa0;2 and phase&#xa0;3&#xa0;trials for various therapies, particularly for immunoglobulin A (IgA) nephropathy and lupus nephritis, are available, raising hopes for a timely approval. For treatment-refractory diseases, both monoclonal and bispecific B cell antibodies as well as occasionally chimeric antigen receptor (CAR) T&#xa0;cells, are being successfully used in individualized treatment approaches.</p> Conclusion <p>A&#xa0;variety of different B&#xa0;cell-targeted therapies are currently in advanced stages of clinical trials. Most therapies are not yet approved, so that patients who do not respond to the available therapies should be given access to trials. Once approved, the challenge will be to select the appropriate (combination) therapy for each individual patient.</p>

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Neue Antikörper gegen B-Zellen in der Nephrologie

  • 期刊论文

  • 发表日期：

    2025年8月26日

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  • Anna Henning,
  • Eva Schrezenmeier,
  • Evelyn Seelow

摘要

Background

The use of immunosuppressive therapies has significantly improved the prognosis of immune-mediated kidney diseases; however, the use of nonspecific therapies, such as cyclophosphamide or bortezomib has so far been limited by substantial toxicity and off-label use. The development of targeted B cell antibodies enables selective interventions in the pathomechanisms with reduced toxicity.

Objective

To provide an overview of current B cell-targeted therapies in nephrology.

Material and methods

Evaluation of case series and reports as well as randomized and controlled trials. Review and discussion of guidelines and research into new approvals by the European Medicines Agency (EMA).

Results

Many B cell therapies are already being used in clinical practice, often off-label due to the lack of controlled trials; however, promising results from phase 2 and phase 3 trials for various therapies, particularly for immunoglobulin A (IgA) nephropathy and lupus nephritis, are available, raising hopes for a timely approval. For treatment-refractory diseases, both monoclonal and bispecific B cell antibodies as well as occasionally chimeric antigen receptor (CAR) T cells, are being successfully used in individualized treatment approaches.

Conclusion

A variety of different B cell-targeted therapies are currently in advanced stages of clinical trials. Most therapies are not yet approved, so that patients who do not respond to the available therapies should be given access to trials. Once approved, the challenge will be to select the appropriate (combination) therapy for each individual patient.