OBELIX-NEPHROSIS: B CELL DEPLETION IN THERAPY-NAÏVE MCD

Treatment options for rare kidney diseases have improved dramatically in the last decade. While this is true for most such diseases, for some there has been little progress and, above all, little interest from the pharmaceutical industry to change this. Most recently, antibodies were discovered in the blood of patients with a rare kidney disease called minimal change disease (MCD). With MCD, no significant abnormalities are found in a kidney biopsy using a standard examination, which is why it is also referred to as a disease with minimal changes. The diagnosis is made using a special pathological examination, called electron microscopy, in combination with clear clinical symptoms. The disease-causing antibodies are directed against proteins that hold the kidney filter together. Suppression of these antibodies is associated with a response to therapy. Such therapies are currently being investigated by researchers in England and France. However, in the meantime there are new developments and probably better treatment options. OBELIX-NEPHROSIS aims to compare a newer therapy option, obinutuzumab, against the established therapy with glucocorticoids. Obinutuzumab is an immunosuppressive drug that suppresses B cells. These cells are responsible for immunological memory (e.g., after a vaccination) and are also involved in the production of the pathological antibodies that trigger MCD. Obinutuzumab is more effective than older B-cell depleting agents such as rituximab in the management of autoimmunity. Our study examines whether obinutuzumab has a positive effect on the long-term course of this disease, especially prevention of disease relapses in comparison to glucocorticoids. Together with our partners in France (Paris and Nice), Germany (Hamburg) and Italy (Rome), we will carry out various experimental studies, which will, on the one hand, allow a better characterization of the disease and, on the other hand, will also enable statements to be made about treatment response and long-term progression. Such investigations are imperative to minimize the risk of disease recurrence over time and thereby reduce exposure to repeated immunosuppression. The latter results in various risks, including the risk of infection and reduced response to vaccinations.