Rituximab for Steroid-Dependent or Frequently Relapsing Idiopathic Nephrotic Syndrome in Adults: A Retrospective, Multicenter Study in Spain

daSilva, Iara; Huerta, Ana; Quintana, Luís F.; Redondo, Beatríz; Iglesias, Elena; Draibe, Juliana; Praga, Manuel; Ballarín, José; Díaz-Encarnación, Montserrat

doi:10.1007/s40259-017-0221-x

Cited by 20 publications

(13 citation statements)

References 37 publications

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“…Most studies also reported that RTX performs better than calcineurin inhibitors for patients with refractory NS. [6][7][8][9]11,[18][19][20][21][22][23][24][25][26] These statistics suggest that RTX is on par or more effective than some of the existing recommended first-line options. A recent meta-analysis also reported the overall remission and relapse of RTX therapy of 53.6% and 47.3%, respectively in FSGS and 80.3% and 35.9% in MCD.…”

Section: Discussionmentioning

confidence: 99%

Consolidation Treatment and Long-Term Prognosis of Rituximab in Minimal Change Disease and Focal Segmental Glomerular Sclerosis

Wang

et al. 2021

DDDT

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Purpose: There is currently a lack of studies investigating long-term prognosis and the necessity of further rituximab (RTX) consolidation treatment for minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). The aim of this study was to evaluate the efficacy of RTX for these diseases and to investigate whether a consolidation treatment can lower risks of relapse and reinforce long-term remission. Patients and Methods: A retrospective study was conducted. The relapse and remission of 70 patients treated with 1 course of RTX treatment (4 infusions of 375 mg/m2) over a median follow-up time of 27 months (12-60 months) were analyzed. The rates of patients that were able to achieve non-relapse for a duration of 24 months between RTX consolidation therapy and non-consolidation therapy were compared. Results: There were 67 cases (95.71%) of remission and 3 cases (4.29%) of non-remission. The average number of relapses decreased from 3.7±2.5 times before the treatment to 0.8 ±1.8 times after treatment (P <0.001). The average avannual number of relapses decreased from 1.3±1.2 times/year to 0.2±0.3 times/year (P <0.001). The results from the Cox proportional-hazards model showed that the risk of relapse in patients who received RTX nonconsolidation treatment was significantly higher than those with consolidation treatment (odds ratios (OR) 20.9, 95% confidence intervals (CI) OR 5.7-75.7, p<0.001). The 24month relapse-free rate was also significantly higher in patients with consolidation therapy compared with non-consolidation therapy (86.36% vs 25%, p<0.001). No adverse events were recorded. Conclusion: RTX is highly effective in treating MCD and FSGS, and RTX consolidation therapy may be recommended to reinforce long-term remissions.

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Section: Discussionmentioning

confidence: 99%

Consolidation Treatment and Long-Term Prognosis of Rituximab in Minimal Change Disease and Focal Segmental Glomerular Sclerosis

Wang

et al. 2021

DDDT

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“…Moreover, in certain researches, patients were already in remission due to previous treatment [ 19 , 27 , 29 ]. Adult patients with biopsy-proven focal segmental glomerulonephritis (FSGS) were enrolled in certain studies [ 20 , 26 – 28 , 30 ]. Last but not least is that different immunosuppressive drugs excluding steroids were used in the RTX protocols [ 20 , 21 , 25 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Extended infusion of rituximab combined with steroids is effective in inducing remission and reducing relapse in adult minimal change disease

et al. 2021

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Background Minimal change disease is a common cause of nephrotic syndrome in adults. Higher relapse rate put patients at risk of steroids toxicity due to long-term exposure. Rituximab has been suggested to maintain long time remission and withdraw steroids and other immunosuppressants with fewer adverse events. However, optimal dose and dosing interval have not been explored. Methods Twenty-five patients were enrolled from 2017-10 to 2020-03 in Nanfang Hospital in China. Clinical and biological data were extracted from medical records and laboratory databases. Therapy composed of 375mg/m2 rituximab once three weeks for 3 dose and corticosteroid was applied. Complete remission was defined as reduction of proteinuria to 0.3g/d. Remission rate, relapse rate, steroids used before and after rituximab therapy and adverse effects were documented at a mean time of 14.71 months. Results Twenty-two patients achieved complete remission for an average of 3.26 months and only 3 patients experienced one relapse respectively during the follow-up period. The mean remission maintenance time was 11.6 months, and was 5 months after steroids withdrawal. Steroids dose at last follow-up was 6.09mg/d, which was significantly reduced compared to 28.15mg/d before rituximab. Relapse rate before and after rituximab was 1.43 and 0.1, respectively. Only four minor adverse events were recorded. Conclusions Therapy consisted of 375mg/m2 rituximab once three weeks for 3 dose combined with corticosteroid is effective in inducing remission in adult patients with minimal change disease. Both of the relapse rate and dose of steroids used are significantly decreased with fewer side effects.

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“…Four studies [16][17][18][19] (102 patients) were included to assess the influence of RTX on disease relapse. The I 2 was 0, so a fixed effects model was used.…”

Section: Rituximab Was Effective In the Treatment Of Sdnsmentioning

confidence: 99%

“…Four studies [16,[19][20][21] registered the influence of RTX on prednisolone dose. Since the I 2 was 50%, moderate heterogeneity existed, and a random effects model was conducted.…”

Section: Rituximab Was Effective In the Treatment Of Sdnsmentioning

confidence: 99%

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Rituximab therapy in adults with steroid-dependent nephrotic syndrome

Zhong

Zhou

et al. 2019

Arch Med Sci

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Introduction: Patients with steroid-dependent nephrotic syndrome (SDNS) suffer frequent relapse with adverse effects caused by long-term prednisolone treatment. Recently, the chimeric monoclonal antibody against the protein CD20 (rituximab-RTX) was observed to be efficacious and safe in the treatment of patients with SDNS. We summarized the scientific literature to evaluate RTX therapy in the clinical management of SDNS. Material and methods: PubMed, EMBASE, and Cochrane Library databases were investigated from interception to 2019-6-6, without language limitation. The analysis was restricted to adults ≥ 19 years of age. Data were administered and analyzed through the Review manager 5.3 software. Results: After RTX treatment, relapse times, prednisolone dose, and proteinuria decreased, whereas serum albumin was increased. The clinical parameters blood pressure and total cholesterol diminished also, whereas bone mineral density was improved. Overall, RTX ameliorated the adverse effects of prednisolone. Moreover, the Th1/Th2 ratio was changed except for the CD19 and CD20 cell counts. Additionally, most of the adverse effects of RTX were mild and well tolerated. Conclusions: In the studies that we considered, we concluded that RTX treatment was effective and safe in the therapy of patients with SDNS. Nevertheless, more randomized controlled trials are required to explore the mechanism of RTX action and verify its efficacy.

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Rituximab for Steroid-Dependent or Frequently Relapsing Idiopathic Nephrotic Syndrome in Adults: A Retrospective, Multicenter Study in Spain

Abstract: Rituximab treatment was safe and well tolerated. It effectively reduced the incidence of relapses and need for maintenance immunosuppressive therapy in adults with difficult-to-treat INS.

Cited by 20 publications

References 37 publications

Consolidation Treatment and Long-Term Prognosis of Rituximab in Minimal Change Disease and Focal Segmental Glomerular Sclerosis

Consolidation Treatment and Long-Term Prognosis of Rituximab in Minimal Change Disease and Focal Segmental Glomerular Sclerosis

Extended infusion of rituximab combined with steroids is effective in inducing remission and reducing relapse in adult minimal change disease

Rituximab therapy in adults with steroid-dependent nephrotic syndrome

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