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Pediatric Nephrology

, 23:1269 | Cite as

Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases

  • Vincent Guigonis
  • Aymeric Dallocchio
  • Véronique Baudouin
  • Maud Dehennault
  • Caroline Hachon-Le Camus
  • Mickael Afanetti
  • Jaap Groothoff
  • Brigitte Llanas
  • Patrick Niaudet
  • Hubert Nivet
  • Natacha Raynaud
  • Sophie Taque
  • Pierre Ronco
  • François Bouissou
Original Article

Abstract

Several case reports suggest that rituximab (RTX) could be effective in steroid-dependent nephrotic syndrome, but RTX efficacy has not yet been studied in a series of patients. Safety and efficacy of RTX were assessed in a multicenter series of 22 patients aged 6.3–22 years with severe steroid-dependent nephrotic syndrome or steroid-resistant but cyclosporin-sensitive idiopathic nephrotic syndrome. Patients were treated with two to four infusions of RTX. Seven patients were nephrotic at the time of RTX treatment. Peripheral B cells were depleted in all subjects. Remission was induced in three of the seven proteinuric patients. One or more immunosuppressive (IS) treatments could be withdrawn in 19 patients (85%), with no relapse of proteinuria and without increasing other IS drugs. RTX was effective in all patients when administered during a proteinuria-free period in association with other IS agents. When relapses occurred, they were always associated with an increase in CD19 cell count. Adverse effects were observed in 45% of cases, but most of them were mild and transient. This study suggests that RTX could be an effective treatment for severe steroid-dependent nephrotic syndrome.

Keywords

Idiopathic nephrotic syndrome Rituximab CD19 B-cell depletion 

Notes

Acknowledgements

We are grateful to Pr. Thibault (Tours, France), Pr. Deschênes (Paris, France) and Dr. François (Paris, France) for helpful discussions and to C. Bahans for proofreading the manuscript.

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Copyright information

© IPNA 2008

Authors and Affiliations

  • Vincent Guigonis
    • 1
  • Aymeric Dallocchio
    • 1
  • Véronique Baudouin
    • 2
  • Maud Dehennault
    • 3
  • Caroline Hachon-Le Camus
    • 4
  • Mickael Afanetti
    • 5
  • Jaap Groothoff
    • 6
  • Brigitte Llanas
    • 7
  • Patrick Niaudet
    • 8
  • Hubert Nivet
    • 9
  • Natacha Raynaud
    • 10
  • Sophie Taque
    • 11
  • Pierre Ronco
    • 12
  • François Bouissou
    • 4
    • 13
  1. 1.Department of Pediatrics, Centre de référence des maladies rénales rares du Sud-OuestHôpital de la mère et de l’enfantLimogesFrance
  2. 2.Pediatric NephrologyHôpital Robert DebréParisFrance
  3. 3.Pediatric NephrologyHôpital Jeanne de FlandresLilleFrance
  4. 4.Centre de référence des maladies rénales rares du Sud-Ouest, Pediatric NephrologyHôpital PurpanToulouseFrance
  5. 5.Pediatric NephrologyHôpital l’Archet IINiceFrance
  6. 6.Pediatric NephrologyEmma Children’s HospitalAmsterdamThe Netherlands
  7. 7.Pediatric Nephrology, Centre de référence des maladies rénales rares du Sud-OuestHôpital PellegrinBordeauxFrance
  8. 8.Pediatric NephrologyHôpital Necker Enfants MaladesParisFrance
  9. 9.Pediatric NephrologyHôpital ClochevilleToursFrance
  10. 10.Pediatric NephrologyHôpital F GuyonLa RéunionFrance
  11. 11.Pediatric NephrologyHôpital de PontchaillouRennesFrance
  12. 12.Department of Nephrology, INSERM, UMR S 702UPMC Univ Paris 06, Hôpital Tenon, AP-HPParisFrance
  13. 13.Centre de référence des maladies révales rares du Sud-QuestToulouseFrance

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