Long-term prognosis of rituximab-induced hypogammaglobulinemia in children with complicated steroid-dependent nephrotic syndrome: impact of multiple rituximab courses

Onuki, Yuta; Fujinaga, Shuichiro

doi:10.1007/s00467-022-05741-9

Cited by 7 publications

(3 citation statements)

References 3 publications

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“…Although no fatal adverse events were observed in our study, six patients required MMF dose reduction or discontinuation owing to adverse events, gastrointestinal symptoms, or hypogammaglobulinemia (Table 4). Hypogammaglobulinemia in patients with NS after rituximab occurs at least once in 43-58% patients [40][41][42][43] and persistently occurs for ≥ 12 months in 22% patients [40], which are similar to the ndings in our study (47% and 23%, respectively). Although a few studies reported MMF maintenance therapy after rituximab as a risk factor for hypogammaglobulinemia [44,45], studies with a large number of patients reported that MMF or the type of IS was not a risk [40][41][42].…”

Section: Discussionsupporting

confidence: 90%

“…Hypogammaglobulinemia in patients with NS after rituximab occurs at least once in 43-58% patients [40][41][42][43] and persistently occurs for ≥ 12 months in 22% patients [40], which are similar to the ndings in our study (47% and 23%, respectively). Although a few studies reported MMF maintenance therapy after rituximab as a risk factor for hypogammaglobulinemia [44,45], studies with a large number of patients reported that MMF or the type of IS was not a risk [40][41][42]. In summary, the combination of rituximab and MMF is safe, but some patients could have side effects, including persistent hypogammaglobulinemia, requiring discontinuation of MMF.…”

Section: Discussionsupporting

confidence: 90%

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Long-term remission by mycophenolate mofetil after single-dose rituximab in children with refractory frequently relapsing/steroid-dependent nephrotic syndrome

Nada,

Kamei,

Nishi

et al. 2024

Preprint

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Background Immunosuppressive agents administered after rituximab as maintenance therapy are effective for sustaining remission in children with refractory frequently relapsing/steroid-dependent nephrotic syndrome (FR/SDNS). We evaluated the long-term outcome and safety of mycophenolate mofetil (MMF) after rituximab. Methods We conducted a retrospective study on patients with childhood-onset refractory FR/SDNS who received MMF after a single dose of rituximab and were followed up ≥ 2 years at three tertiary pediatric nephrology centers. Relapses, additional treatment, risk factors for relapse, and adverse events were analysed. Results A total of 106 patients were enrolled, and 47 (44%) patients had no relapse under MMF with a median relapse-free period of 3.2 years and interquartile range of 2.7–3.8 years. The 50% relapse-free survival was 3.2 years during MMF administration as shown by the Kaplan–Meier method. Sixty-one (58%) patients required additional doses of rituximab during a median follow-up of 7.2 years. The mean annual number of relapses before the first rituximab treatment versus 1 year after rituximab was 3.7 (SD 1.3) versus 0.4 (SD 0.8) times. Sixty-six of 74 (89%) patients using a calcineurin inhibitor immediately before rituximab discontinued its use within 1 year. A dosage of MMF < 1000 mg/m2 was an independent significant risk factor for the first relapse under MMF after rituximab (p = 0.03). No fatal adverse events were observed. Conclusions MMF after a single dose of rituximab is safe and effective in achieving a long relapse-free period and discontinuing a calcineurin inhibitor in patients with refractory FR/SDNS.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Long-term remission by mycophenolate mofetil after single-dose rituximab in children with refractory frequently relapsing/steroid-dependent nephrotic syndrome

Nada,

Kamei,

Nishi

et al. 2024

Preprint

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“…It is important to note that the adverse reaction pro les of rituximab in both groups were consistent with its known safety pro le [9,10], with no serious adverse events reported. This reinforces the acceptability of rituximab as a maintenance therapy option, despite the need for close monitoring for potential infusion reactions and infections.…”

Section: Discussionsupporting

confidence: 74%

Rituximab as a Maintenance Therapy in Pediatric Patients with Frequent-Relapsing or Steroid Dependent Nephrotic Syndrome: Efficacy, Safety, and Steroid Reduction

Wu,

Chen,

Cao

et al. 2024

Preprint

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Background: Nephrotic syndrome is the most common glomerular disease in pediatrics. Rituximab has been shown to induce remission in nephrotic syndrome, yet the necessity and safety of its use in maintenance therapy remain uncertain. In this study, we detail our clinical experience with the application of rituximab in the maintenance treatment of pediatric nephrotic syndrome, aiming to offer an additional therapeutic option for patients. Methods: In a retrospective study conducted at the Second Xiangya Hospital of Central South University from January 2020 to June 2023, we evaluated pediatric patients with frequent-relapsing or steroid-dependent nephrotic syndrome who received rituximab treatment. All patients received induction therapy with rituximab for remission. Based on the subsequent maintenance treatment regimen, patients were divided into two groups: Group 1 (n=12) received traditional immunosuppressive therapy for maintenance, and Group 2 (n=23) received rituximab maintenance every six months. We collected and analyzed data regarding steroid discontinuation, treatment outcomes, and the incidence of adverse events. Results: The primary outcomes measured were steroid discontinuation rate and the minimum steroid dosage required to maintain remission. Group 2 exhibited a significantly higher steroid withdrawal rate (P<0.05) and a lower minimum steroid dose for remission maintenance (P<0.05) compared to Group 1. However, the differences in steroid-free survival time (P=0.390), time to first recurrence (P=0.794), and relapse-free survival duration (P=0.199) between the two groups were not statistically significant. Adverse events were observed in both groups, with infusion reactions and infections being the most common. No serious adverse events were reported in either group. Conclusions: In conclusion, our retrospective analysis demonstrates that rituximab maintenance therapy is an effective strategy for managing pediatric patients with frequent-relapsing or steroid-dependent nephrotic syndrome. The therapy significantly increased the steroid withdrawal rate and reduced the required steroid dosage, thereby potentially mitigating the long-term adverse effects associated with steroid use. The side effects observed were acceptable.

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Efficacy and safety of long-term repeated use of rituximab in pediatric patients with nephrotic syndrome

Choi,

Min,

Kim

et al. 2023

Pediatr Nephrol

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BackgroundWe aimed to investigate the e cacy and safety of long-term repeated use of Rituximab (RTX) in pediatric patients with nephrotic syndrome (NS). MethodsRetrospective review of medical records for 50 patients with steroid-dependent NS (SDNS) who had received more than three cycles of RTX was conducted; each consisted of one to four infusions of RTX until B lymphocytes were depleted. ResultsThe median age of starting the rst RTX cycle was 12.4 years (interquartile ranges (IQR) 10.2-14.6).During a median follow-up period of 6.3 (IQR 3.6-8.6) years, patients received a median of 5.0 RTX cycles (IQR 4.0-7.3). The number of relapses decreased from a median of 2.0 relapses per year (IQR 1.0-3.0) to 0.2 relapses per year (IQR 0.0-0.5) after long-term RTX treatments (P < 0.001). Longer relapse-free periods were associated with more than four RTX cycles, longer B cell depletion, older age at each RTX treatment, and lower cholesterol levels. B lymphocytes recovered to 1% at a median of 5.9 months (95% con dence interval (CI) 5.7-6.1) after RTX administration. Factors related to a longer period of B-cell depletion included more than ve RTX cycles, a higher dose of RTX, older age at treatment, and concurrent use of antimetabolites. During repeated RTX treatments, 11%, 6%, and 2% of patients developed hypogammaglobulinemia, severe infection, and severe neutropenia, respectively. ConclusionsLong-term repeated use of RTX was effective and safe in pediatric NS patients. Furthermore, the redosing of RTX could be chosen by considering predictive factors for relapse-free and B-cell depletion periods.

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Long-term prognosis of rituximab-induced hypogammaglobulinemia in children with complicated steroid-dependent nephrotic syndrome: impact of multiple rituximab courses

Cited by 7 publications

References 3 publications

Long-term remission by mycophenolate mofetil after single-dose rituximab in children with refractory frequently relapsing/steroid-dependent nephrotic syndrome

Long-term remission by mycophenolate mofetil after single-dose rituximab in children with refractory frequently relapsing/steroid-dependent nephrotic syndrome

Rituximab as a Maintenance Therapy in Pediatric Patients with Frequent-Relapsing or Steroid Dependent Nephrotic Syndrome: Efficacy, Safety, and Steroid Reduction

Efficacy and safety of long-term repeated use of rituximab in pediatric patients with nephrotic syndrome

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