Rituximab in Minimal Change Disease

Madanchi, Nima; Bitzan, Martin; Takano, Tomoko

doi:10.1177/2054358117698667

Cited by 19 publications

(15 citation statements)

References 161 publications

(241 reference statements)

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“…MCD is thought to be T cell-mediated; thus, the role of rituximab in this disease is still unclear. Some published clinical studies have described the efficacy of rituximab in MCD in pediatric patients; however, its clinical role in adult patients remains undetermined [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Off-Label Use of Rituximab in Patients with Different Types of Nephropathies in a Tertiary Hospital: A Retrospective Study

Sans-Pola

Agustí

Bosch

et al. 2021

JCM

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Off-label use of rituximab is commonly requested for patients with resistant nephropathies. The outcomes and tolerability of rituximab in adult patients with nephropathy treated at our hospital (from 2013 to 2018) were described. Data were retrieved from electronic medical records. Response was classified as complete remission (CR), partial remission (PR), or no response (NR) according to the KDIGO criteria. A total of 89 requests were received for 61 patients. Median age was 58 years (45.9% female). Idiopathic membranous nephropathy (MN) (n = 30) was the most frequent indication, followed by minimal change disease (MCD) (n = 15) and secondary membranoproliferative glomerulonephritis (MPGN) (n = 12). Three patients with focal segmental glomerulosclerosis (FSGS) were included. After most treatment cycles in MN, a CR or PR was observed; median proteinuria levels significantly decreased for these patients (6000 mg/24h (IQR 3584–10,300) vs. 1468.8 (IQR 500–4604.25), p < 0.01). In MPGN, no response was documented after 46.7% of rituximab cycles. A CR or PR was described with the majority of rituximab cycles in MCD, with a significant decrease in proteinuria (6000 mg/24 h (IQR 4007–11,426) vs. 196.8 (IQR 100–1300), p = 0.013). No cycles produced a response in FSGS. Mean CD19+ B-cell decreased in all types of nephropathy (10.44% vs. 0.29%, p < 0.0001). Eleven patients presented infusion-related reactions, and 17 presented infectious complications. The majority of patients with MN and MCD had complete or partial responses; however, neither MPGN nor FSGS had encouraging results.

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Section: Introductionmentioning

confidence: 99%

Off-Label Use of Rituximab in Patients with Different Types of Nephropathies in a Tertiary Hospital: A Retrospective Study

Sans-Pola

Agustí

Bosch

et al. 2021

JCM

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“…Almost all studies showed that RTX was effective in the treatment of refractory NS in children, and it could Azarfar et al hypercholesterolemia (2). Approximately 20% of children do not respond completely and have steroid-resistant NS (SRNS), and 80%-90% of children with steroidsensitive nephrotic syndrome (SSNS) experience relapses.…”

Section: Discussionmentioning

confidence: 99%

“…According to the NS clinical guidelines, for the management of children who develop frequentlyrelapsing NS (FRNS) or steroid-dependent NS (SDNS), a low-dose alternate day steroid regimen, as the first-line treatment, is prescribed (1). Long-term glucocorticoid use in FRNS/SDNS patients leads to reduced bone mineral density, hypertension, increased infection risks, comorbidities such as cushingoid habitus, growth retardation, striae and acne, cataracts, pseudotumor cerebri, impaired glucose tolerance and hypercholesterolemia (2). Approximately 20% of children do not respond completely and have steroid-resistant NS (SRNS), and 80%-90% of children with steroid-sensitive NS (SSNS) experience relapses.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of rituximab in children with difficult-to-treat nephrotic syndrome; a systematic review

Azarfar¹,

Ravanshad²,

Mehrad‐Majd³

et al. 2018

J Renal Inj Prev

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“…Frequent relapses, steroid-dependence, or steroid-resistance require repeated courses of treatment ( 9 ). Thereby, high doses and long-term steroid treatments are needed, frequently leading to adverse effects and toxicity ( 1 , 13 ). Therefore, alternative immunosuppressive treatments are applied in these patients, including alkylating agents, calcineurin inhibitors, mycophenolate mofetil, and rituximab ( 1 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…On the other side, CD20 is not expressed on human podocytes ( 18 ). Depletion of CD20 expressing cells using rituximab has shown promising results in the treatment of MCD ( 10 , 13 , 19 , 20 ), leading to the hypothesis that B cells have a pathogenetic role in MCD. Nonetheless, the precise mechanisms of action of rituximab in the treatment of MCD are unknown ( 9 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

Rituximab Induces Complete Remission of Proteinuria in a Patient With Minimal Change Disease and No Detectable B Cells

et al. 2021

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Minimal change disease (MCD) is a common cause of nephrotic syndrome. Treatment with steroids is usually effective, but frequent relapses are therapeutic challenges. The anti-CD20 antibody rituximab has shown promising results for treatment of steroid-sensitive nephrotic syndrome. Since predictive biomarkers for treatment efficacy and the accurate rituximab dosage for effective induction of remission are unknown, measurement of CD19+ B cells in blood is often used as marker of successful B cell depletion and treatment efficacy. A male patient with relapsing MCD was successfully treated with rituximab, but developed relapse of proteinuria 1 year later, although no B cells were detectable in his blood. B and T cell populations in the patient’s blood were analyzed before and after treatment with rituximab using FACS analysis. Rituximab binding to B and T cells were measured using Alexa Fluor 647 conjugated rituximab. We identified a population of CD20+ CD19− cells in the patient’s blood, which consisted mostly of CD20+ CD3+ T cells. Despite the absence of B cells in the blood, the patient was again treated with rituximab. He developed complete remission of proteinuria and depletion of CD20+ T cells. In a control patient with relapsing MCD initial treatment with rituximab led to depletion of both CD20+ B and T cells. Rituximab induces remission of proteinuria in patients with MCD even if circulating B cells are absent. CD20+ T cells may play a role in the pathogenesis of MCD and might be a promising treatment target in patients with MCD.

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Rituximab in Minimal Change Disease

Cited by 19 publications

References 161 publications

Off-Label Use of Rituximab in Patients with Different Types of Nephropathies in a Tertiary Hospital: A Retrospective Study

Off-Label Use of Rituximab in Patients with Different Types of Nephropathies in a Tertiary Hospital: A Retrospective Study

Efficacy and Safety of rituximab in children with difficult-to-treat nephrotic syndrome; a systematic review

Rituximab Induces Complete Remission of Proteinuria in a Patient With Minimal Change Disease and No Detectable B Cells

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