10-Летний Личный Опыт Применения Ритуксимаба У Нефрологических Пациентов

Иванов, Д Д; Dyadyk, Olena O; Rotova, S.O.; Ivanovа, M.D.

doi:10.22141/2307-1257.9.2.2020.203409

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…The frequency of maintenance doses may be linked to the recovery of CD20-positive B-cells. Notably, our previous experience supports the safety of 2-year maintenance treatment with RTX, ensuring a relapse-free course of NS [15].…”

Section: Discussionsupporting

confidence: 69%

“…The aforementioned considerations, coupled with personal experiences [15] and challenges in providing medical care during a state of war [16], have led to the proposition of utilizing RTX as an early-prescribing drug for children with glomerulopathies that exhibit a recurrent or progressive course with declining eGFR or increasing albuminuria/proteinuria. This approach, involving physician-controlled intravenous infusions, aims to ensure ambulatory treatment with virtual supervision for six months, enhance e cacy compared to traditional rst-line drugs, minimize side effects, and position RTX as a rst-line therapy alternative.…”

mentioning

confidence: 99%

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Rituximab Administration in Pediatric Glomerulopathies Amid Challenging Circumstances: Insights from Clinical Experience

Ivanov,

Weber,

Lagodych

et al. 2024

Preprint

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Background: The ISN Green Nephrology Initiative, coupled with limited capacity in low-middle-income countries and the challenges posed by military conflicts, necessitates innovative solutions in pediatric nephrology for optimizing the treatment of children with kidney diseases. This study aims to assess the effectiveness and safety of Rituximab (RTX) usage in children with glomerular diseases, with an extension of clinical indications.Methods: We initiated an ongoing open-label, multicenter, randomized, patient-oriented study, termed RIME ("RTX in glomerulopathies"), focusing on children with glomerulopathies in Ukraine during martial law (enrolled 2022–2023). Inclusion criteria comprised patients with steroid-dependent (SDNS) or frequently relapsing nephrotic syndrome (FRNS) and progressive glomerulopathies, as determined by eGFR (estimated glomerular filtration rate), ACR (albumin-to-creatinine ratio), and kidney biopsy results. RTX was explored as an alternative to glucocorticoid re-administration and a potential treatment to decelerate renal function decline. The primary endpoint was eGFR and ACR up to 6 months from RTX initiation, with the secondary endpoint assessing the delayed effect at 1 year.Results: As of November 2023, results were available for 19 children, including 7 with FRNS and 12 with progressive loss of renal function and/or increased ACR. RTX use resulted in stable remission of steroid-dependent FRNS, with statistically significant urinalysis normalization and hyperfiltration by the 6th month, leading to eGFR normalization within a year. RTX demonstrated a 75% success rate in achieving a stable trend in reducing ACR and restoring eGFR in progressive glomerulopaties. In this group, stable trends did not receive statistically significant changes, which is obviously due to the small size of the sample. Tolerability was observed in 80% of patients, allowing completion of the full course of therapy.Conclusions: RTX, if tolerated, proved highly effective as a steroid-sparing agent and demonstrated efficiency in slowing the pathological process in progressive glomerulopathies, indicating the potential for ACR reduction and renal function restoration. Future studies should assess the balance between treatment cost, convenience, adherence to Green Nephrology principles, and the feasibility of a virtual nephrology approach in conflict zones.

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Section: Discussionsupporting

confidence: 69%

mentioning

confidence: 99%

Rituximab Administration in Pediatric Glomerulopathies Amid Challenging Circumstances: Insights from Clinical Experience

Ivanov,

Weber,

Lagodych

et al. 2024

Preprint

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Infusion reactions to rituximab administration: algorithm of management

Ivanov

Zavalna

2022

KIDNEYS

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Background. Allergic reactions to rituximab, which have been used for the past 20 years, are common in 32–62 % of patients. The purpose of the study: to develop an algorithm for controlling adverse reactions that occur during the introduction of rituximab. Materials and methods. The personal experience of treatment of 46 patients with various kidney diseases who received rituximab according to the indications according to the established diagnosis was analyzed. Evaluation of infusion allergic reactions was performed according to P.М. Kasi et al. (2012) for 5 classes of side effects. Results. It was found that allergic reactions to rituximab occurred in 46 % of patients in the range from 1 to 4 classes. The probability of their occurrence according to the class was almost the same, but somewhat less documented for the 4th grade. Re-administration of diphenhydramine, methylprednisolone 125 mg or hydrocortisone 125 mg, if necessary salbutamol, oxygen allowed to eliminate most of the reaction, and then resumed the introduction of rituximab, starting from 25 mg/h, gradually increasing to 300 mg/h. This administration, performed 1–2 times, was effective in 1–3 classes of allergic reactions. For fourth grade, one patient required omalizumab. Generalized experience allowed to give a graphical and descriptive algorithm of actions in case of infusion side effects for rituximab. Conclusions. Based on special data and literature analysis, an algorithm for controlling infusion allergic reactions with intravenous rituximab was formulated.

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Rituximab use in the treatment of children with nephrotic syndrome

Вакуленко¹,

Lytvynova

Posmitjuha

2022

KIDNEYS

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Background. High recurrence rates of nephrotic syndrome in children and consequences in the form of steroid dependence and a high risk of side effects from corticosteroids as a result involve immunosuppressive steroid-preserving agents that would increase long-term remission. Rituximab, a chimeric anti-CD20 monoclonal antibody that inhibits CD20-mediated B-cell proliferation and differentiation, has been identified as a possible alternative treatment. The purpose of the study — to estimate the efficacy and safety of treatment recurrence of nephrotic syndrome in children using rituximab like we did it on three clinical cases. Materials and methods. The experience of rituximab in children was analyzed according to the databases of Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health and our own study of the treatment of three children with steroid-sensitive nephrotic syndrome was presented. Results. Treatment of nephrotic syndrome in three children who are 5 to 7 years with rituximab was conducted. One child had a second recurrence, two children had a first recurrence. The previous episode of nephrotic syndrome in all children was treated according to the recommendations of KDIGO 2021. All patients received rituximab (two intravenous injections two weeks apart) at a dose of 15 mg/kg for 5–6 hours with prior administration of methylprednisolone at a dose of 7–10 mg/kg. One child had side effects to the first administration of rituximab in the form of hypotension 70/40 and tachycardia 116–118. Reducing the speed of administration helped to eliminate side effects. The next injection in two weeks the child endured well. The other two children had no side effects to both rituximab injections. Moreover after 1 month of rituximab administration was without side effects or hematological changes. The next administration of rituximab is scheduled in 6 months after the last administration with prior control of CD20 level. Conclusions. In general a review of studies of rituximab confirms the high efficacy of the medication in nephrotic syndrome in children and the requirement for long-term evaluation. Rituximab can be considered as a first-line treatment for recurrence of nephrotic syndrome, including in resource-limited settings. Our own experience with rituximab in recurrent nephrotic syndrome has revealed slight short-term side effects.

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10-Летний Личный Опыт Применения Ритуксимаба У Нефрологических Пациентов

Cited by 5 publications

References 5 publications

Rituximab Administration in Pediatric Glomerulopathies Amid Challenging Circumstances: Insights from Clinical Experience

Rituximab Administration in Pediatric Glomerulopathies Amid Challenging Circumstances: Insights from Clinical Experience

Infusion reactions to rituximab administration: algorithm of management

Rituximab use in the treatment of children with nephrotic syndrome

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