Biologicals

Over the last years the therapeutic use of biologicals in the treatment of autoimmune diseases and disorders of the complement system has been introduced into clinical practice. Most experience has been gained with the use of the anti-CD20 antibody rituximab. The efficacy of rituximab in the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated diseases has been shown in randomized trials. Rituximab is also effective in the treatment of membranous glomerulonephritis, cryoglobulinemia and treatment-resistant lupus nephritis but the available data are insufficient for general recommendations with high evidence. The role of rituximab in the treatment of other kidney diseases (e.g. focal segmental glomerulosclerosis FSGS) is unclear. For belimumab, which is approved for the treatment of systemic lupus erythematosus (SLE), no recommendations for the use in lupus nephritis can be given due to the lack of studies. Eculizumab is approved for the treatment of atypical hemolytic-uremic syndrome (aHUS); however, currently there are uncertainties about the indications and therapeutic strategies in the treatment of aHUS and complement-associated forms of membranoproliferative glomerulonephritis (MPGN). New randomized studies are needed to clarify the role of biologicals in the treatment of immunological renal diseases.