Pediatric Nephrology

, Volume 25, Issue 3, pp 539–544

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

  • Shuichiro Fujinaga
  • Daishi Hirano
  • Naoto Nishizaki
  • Koichi Kamei
  • Shuichi Ito
  • Yoshiyuki Ohtomo
  • Toshiaki Shimizu
  • Kazunari Kaneko
Brief Report

Abstract

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/m2) 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.

Keywords

Rituximab Steroid-dependent nephrotic syndrome Minimal-change disease Cyclosporine 

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Copyright information

© IPNA 2009

Authors and Affiliations

  • Shuichiro Fujinaga
    • 1
  • Daishi Hirano
    • 1
  • Naoto Nishizaki
    • 1
  • Koichi Kamei
    • 2
  • Shuichi Ito
    • 2
  • Yoshiyuki Ohtomo
    • 3
  • Toshiaki Shimizu
    • 4
  • Kazunari Kaneko
    • 5
  1. 1.Division of NephrologySaitama Children′s Medical CenterSaitama-cityJapan
  2. 2.Division of NephrologyNational Center for Child Health and DevelopmentTokyoJapan
  3. 3.Department of PediatricsJuntendo Nerima HospitalTokyoJapan
  4. 4.Department of PediatricsJuntendo University School of MedicineTokyoJapan
  5. 5.Department of PediatricsKansai Medical UniversityOsakaJapan

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