Nephrotic syndrome and rituximab: facts and perspectives

Haffner, Dieter; Fischer, Dagmar‐Christiane

doi:10.1007/s00467-009-1226-6

Cited by 37 publications

(29 citation statements)

References 24 publications

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“…RTX is a chimeric monoclonal antibody directed against the CD20 antigen, which is a membranous protein found on B cells. It has been successfully used in patients with B-cell lymphoma autoimmune disease such as systemic lupus erythematosus [16]. In addition, several case reports have suggested Fig.…”

Section: Discussionmentioning

confidence: 99%

Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine

et al. 2010

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Rituximab (RTX) has been successfully used as a rescue therapy in children with steroid-dependent nephrotic syndrome (SDNS). However, little is known regarding maintenance therapy after a successful response to RTX in such patients. The efficacy and safety of a single RTX infusion (375 mg/m(2)) were assessed in ten patients who had persistent SDNS associated with minimal-change disease (MCD) despite the long-term use of cyclosporine (CsA). The mean follow-up after RTX infusion was 17 months. Applying RTX resulted in a significant reduction in the mean prednisolone (PSL) dose from 0.39 +/-0.18 to 0.15 +/- 0.14 mg/kg per day. The mean 12-month relapse rates significantly decreased from 4.1 +/- 1.7 to 0.6 +/- 0.6. All but one patient who had continued CsA as maintenance therapy after a single RTX infusion were able to withdraw from PSL without any relapses during the study period, whereas the remaining five patients who discontinued CsA experienced relapses after CD19 cells re-emerged, leading to the reintroduction of CsA or an additional RTX infusion. Infusion reactions occurred in five of ten patients. These data indicate that a single RTX infusion may improve response to CsA in patients with persistent SDNS due to the phenomenon of secondary resistance to CsA.

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Section: Discussionmentioning

confidence: 99%

Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine

et al. 2010

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“…However, a number of recent clinical observations provided evidence of an important role for B cells in the development of NS including our study [27,28,29]. In fact, RTX can be effective in treating patients with refractory NS [6,7,30] while it has been successfully used in patients with B-cell lymphoma and autoimmune disease such as systemic lupus erythematosus [31]. These results may imply that RTX can prevent relapses in refractory NS by attenuating T-cell function via inhibition on the interaction between B cells and activated T cells.…”

Section: Discussionmentioning

confidence: 99%

Novel Use of Rituximab for Steroid-Dependent Nephrotic Syndrome in Children

et al. 2013

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Background: Though rituximab (RTX) is effective for childhood steroid-dependent nephrotic syndrome (SDNS), an established regimen does not exist. The relapses tend to occur when the peripheral blood B-cell count re-arises at 3 months upon single RTX infusion. This study was conducted to clarify whether the long-term remission of SDNS can be obtained by repeated RTX administrations. Methods: RTX was administered 4 times at 3-month intervals at 375 mg/m²/time to 5 children with SDNS. The changes in the clinical indicators were analyzed. Results: The median (range) observation period was 6.3 (0.9-8.4) years before RTX and 3.2 (1.9-3.8) years following the commencement of RTX. The changes in the clinical indicators were as follows (median and range): (1) annual number of relapses: before administration 1.4 (1.1-3.5) times/year, after administration 0.0 (0.0-0.0) times/year, and (2) median steroid dosage: before administration 0.80 (0.23-0.96) mg/kg/day, after administration 0.00 (0.00-0.00) mg/kg/day. All changes were significant at p < 0.05. Relapse occurred 3 times following the start of RTX (the period to relapse was 2.2, 1.9, and 2.3 years, respectively). No serious side effects were seen. Conclusions: Repeated RTX against SDNS in children may be a useful therapeutic option.

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“…In these, alkylating agents, calcineurin inhibitors, antiproliferative and immunomodulatory agents have been used as steroid-sparing agents, with a mixed response reported. There are increasing data from observational studies on the use of rituximab in steroid-resistant (SRNS) and steroid-dependent (SDNS) nephrotic syndrome in children [usually secondary to MCD or focal segmental glomerulosclerosis (FSGS)] [50,51]. Less has been published with regard to adults, and randomized trials are lacking in both populations.…”

Section: Clinical Use Of Rituximabmentioning

confidence: 99%

Update on Rituximab: An Established Treatment for All Immune-Mediated Kidney Diseases?

Evans

Salama²

2014

Nephron Clin Pract

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Rituximab, a monoclonal antibody directed against the CD20 antigen, found on certain B-cell subsets, results in significant B-cell depletion and has been increasingly used in immune-mediated renal disease and transplantation. Although originally applied to what were considered antibody-mediated diseases, it has become clear that auto- and alloreactive B cells contribute in many ways to immune dysfunction, and the benefit of B-cell depletion extends beyond reduction in auto- or alloantibody levels. Most positive data regarding the benefit of rituximab in immune-mediated kidney disease have come from uncontrolled cohort studies, with the only positive controlled clinical trials demonstrating efficacy for the treatment of systemic vasculitis. While negative trials may have potentially missed clinical effects due to trial design, there may be significant differences in responses in different diseases or lack of efficacy due to therapeutic overlap when used with certain drug combinations. Rituximab is a novel treatment that provides a clear alternative for patients in different clinical situations, and allows for customization of therapy. However, much remains to be understood as to how best to use it in a cost-effective manner, when not to use it, and what the long-term impact of therapy may be.

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Nephrotic syndrome and rituximab: facts and perspectives

Cited by 37 publications

References 24 publications

Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine

Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine

Novel Use of Rituximab for Steroid-Dependent Nephrotic Syndrome in Children

Update on Rituximab: An Established Treatment for All Immune-Mediated Kidney Diseases?

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