Effect of single-dose rituximab on steroid-dependent minimal-change nephrotic syndrome in adults

Takei, Takashi; Itabashi, Mitsuyo; Moriyama, Takahito; Kojima, Chiari; Shiohira, Syunji; Shimizu, Ari; Tsuruta, Yuki; Ochi, Ayami; Amemiya, Nobuyuki; Mochizuki, Toshio; Uchida, Keiko; Tsuchiya, Ken; Nitta, Kosaku

doi:10.1093/ndt/gfs515

Cited by 66 publications

(80 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…26 The pathogenic role of B lymphocytes would also explain why MCD or FSGS may occasionally occur in patients with other B cell-mediated diseases 27 and why NS remission achieved by rituximab associates with circulating B-cell depletion. [8][9][10][11][12][13][14]26 In patients in this study, persistence of remission after B lymphocyte reappearance in the circulation could actually be the result of a complete and definitive disruption of the potential autoreactive clone(s). This is in line with the evidence that in IMN, persistent remission achieved by rituximab therapy is paralleled by depletion of nephritogenic autoantibodies, even after re-emergence of B lymphocytes in the circulation.…”

Section: Discussionmentioning

confidence: 77%

“…After the first occasional observation 7 and small uncontrolled studies suggesting the efficacy of B-lymphocyte depletion in children with MCD, 8,9,11-13 a recent observational study suggested that rituximab therapy may reduce the incidence of recurrences in adults with the same disease. 14 Within the limitation of the small sample size, comparative analyses according to patient age either at inclusion or at disease onset suggest that rituximab treatment may be equally effective in children and adults, independent of the underlying pathology. On the other hand, our present data convey the fully novel and clinically relevant message that rituximab may be uniformly effective in patients with steroid-sensitive idiopathic FSGS, regardless of age, which has major clinical relevance.…”

Section: Discussionmentioning

confidence: 99%

“…Controlled studies in support of this hypothesis, however, have been both scanty and almost confined to children 12,13 or to patients with MCD who were evaluated in the context of a retrospective, observational design. 14 Indeed, less attention was given to adults and patients with FSGS given difficulties in designing adequately powered trials.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Rituximab in Steroid-Dependent or Frequently Relapsing Idiopathic Nephrotic Syndrome

Ruggenenti

Ruggiero

Cravedi

et al. 2014

Journal of the American Society of Nephrology

211

187

View full text Add to dashboard Cite

The outcome of steroid-dependent or frequently relapsing nephrotic syndrome of minimal change disease (MCD), mesangial proliferative GN (MesGN), or FSGS may be poor and with major treatment toxicity. This academic, multicenter, off-on trial (ClinicalTrials.gov #NCT00981838) primarily evaluated the effects of rituximab therapy followed by immunosuppression withdrawal on disease recurrence in 10 children and 20 adults with MCD/MesGN (n=22) or FSGS who had suffered $2 recurrences over the previous year and were in steroidinduced remission for $1 month. Participants received one dose (n=28) or two doses of rituximab (375 mg/m 2 intravenously). At 1 year, all patients were in remission: 18 were treatment-free and 15 never relapsed. Compared with the year before rituximab treatment, total relapses decreased from 88 to 22 and the per-patient median number of relapses decreased from 2.5 (interquartile range [IQR], 2-4) to 0.5 (IQR, 0-1; P,0.001) during 1 year of follow-up. Reduction was significant across subgroups (children, adults, MCD/MesGN, and FSGS; P,0.01). After rituximab, the per-patient steroid maintenance median dose decreased from 0.27 mg/kg (IQR, 0.19-0.60) to 0 mg/kg (IQR, 0-0.23) (P,0.001), and the median cumulative dose to achieve relapse remission decreased from 19.5 mg/kg (IQR, 13.0-29.2) to 0.5 mg/kg (IQR, 0-9.4) (P,0.001). Furthermore, the mean estimated GFR increased from 111.3625.7 to 121.8629.2 ml/min per 1.73 m 2 (P=0.01), with the largest increases in children and in FSGS subgroups. The mean height z score slope stabilized in children (P,0.01). Treatment was well tolerated. Rituximab effectively and safely prevented recurrences and reduced the need for immunosuppression in steroiddependent or frequently relapsing nephrotic syndrome, and halted disease-associated growth deficit in children.

show abstract

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rituximab in Steroid-Dependent or Frequently Relapsing Idiopathic Nephrotic Syndrome

Ruggenenti

Ruggiero

Cravedi

et al. 2014

Journal of the American Society of Nephrology

211

187

View full text Add to dashboard Cite

show abstract

“…These initial findings were corroborated by a number of other case reports and retrospective and prospective studies (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Rituximab generally induced sustained remission allowing for a marked reduction or discontinuation of corticosteroids and/or immunosuppressive drugs in patients with MCD who were steroid dependent or frequent relapsers (24).…”

Section: Discussion Of Casementioning

confidence: 57%

“…Rituximab generally induced sustained remission allowing for a marked reduction or discontinuation of corticosteroids and/or immunosuppressive drugs in patients with MCD who were steroid dependent or frequent relapsers (24). Rituximab appears to be more effective when given to patients in complete remission, but a few nephrotic patients also responded (18). It also appears to be beneficial to patients who are steroid resistant (10,11,25).…”

Section: Discussion Of Casementioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2013

Fervenza

Perazella

Choi

2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

The Nephrology Quiz and Questionnaire (NQ&Q) remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall of the 2013 meeting was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories, along with single best answer questions, were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the NQ&Q was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of caseoriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responses and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for CJASN readers. Enjoy the clinical cases and expert discussions.

show abstract

Minimal Change Disease and Focal Segmental Glomerulosclerosis in Adults

Zhang

2022

Evidence‐Based Nephrology

View full text Add to dashboard Cite

Effect of single-dose rituximab on steroid-dependent minimal-change nephrotic syndrome in adults

Cited by 66 publications

References 23 publications

Rituximab in Steroid-Dependent or Frequently Relapsing Idiopathic Nephrotic Syndrome

Rituximab in Steroid-Dependent or Frequently Relapsing Idiopathic Nephrotic Syndrome

American Society of Nephrology Quiz and Questionnaire 2013

Minimal Change Disease and Focal Segmental Glomerulosclerosis in Adults

Contact Info

Product

Resources

About