Therapeutic efficacy of rituximab for the management of adult-onset steroid-dependent nephrotic syndrome: a retrospective study
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Recent reports have described the efficacy of rituximab in treating steroid-dependent nephrotic syndrome (SDNS) in pediatric patients. However, few reports describe data regarding adult-onset SDNS. We investigated the efficacy of rituximab for the management of adult-onset SDNS.
We performed a retrospective cohort study investigating eight patients with adult-onset SDNS who were treated with rituximab. Clinical data were obtained at the initiation of rituximab therapy. The primary outcomes evaluated were successful suppression of relapses and CD19+ cells after rituximab treatment. The corticosteroid- and immunosuppressant-sparing effect and adverse events were additionally evaluated.
All eight patients were diagnosed with minimal change nephrotic syndrome and received immunosuppressants in addition to corticosteroid. Total number of relapses was 10.5 times as a median value. Rituximab administration was repeated in two patients, whereas six received single-dose rituximab. Three of eight (37.5%) patients showed relapse after rituximab therapy. A rituximab-induced depletion in CD19+ cells noted initially was followed by their reappearance in all patients. There were cases with no relapse after the reappearance of CD19+ cells. The median relapse time pre- and post-rituximab therapy showed a decrease from 1 time/year (interquartile range [IQR] 1–3 times/year) to 0 time/year (IQR 0–1 time/year). Rituximab treatment induced a significant reduction in the required doses of corticosteroid and cyclosporine (P < 0.01). No serious adverse events were observed.
Rituximab treatment was effective not only in childhood-onset but also in adult-onset SDNS. Further studies are needed to establish optimal treatment regimens.
KeywordsAdult-onset Steroid-dependent nephrotic syndrome Frequently relapsing nephrotic syndrome Minimal change nephrotic syndrome Rituximab
This study was supported partly by a Grant-in-Aid for Progressive Renal Diseases Research, and Research on Rare and Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.
Compliance with ethical standards
Conflict of interest
The Department of Nephrology and Rheumatology, Aichi Medical University received research promotion grants from Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Co., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Limited., and Torii Pharmaceutical Co., Ltd. The Department of Nephrology, Nagoya University Graduate School of Medicine received research promotion grants from Astellas Pharma Inc., Bristol-Myers Squibb., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical Co., Ltd., MSD K.K., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Limited., Torii Pharmaceutical Co., Ltd., and Sumitomo Dainippon Pharma Co., Ltd.
Human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of The Ethics Committee for Human Research of Nagoya University Hospital at which the studies were conducted (IRB approval number 2017-0192) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The Ethical Committee approved this retrospective cohort study without written informed consent from patients; however, informed consent was obtained from most patients at the time of performing a renal biopsy.
- 14.Iijima K, Sako M, Nozu K, Mori R, Tuchida N, Kamei K, et al. Rituximab for childhood-onset, complicated, frequently relapsing nephrotic syndrome or steroid-dependent nephrotic syndrome: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet. 2014;384:1273–81.CrossRefGoogle Scholar