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Efficacy of repeat-dose rituximab maintenance therapy for minimal change disease in adults

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Abstract

Background

Rituximab (RTX) has been reported to effectively treat minimal change disease (MCD) in adults. However, the efficacy of RTX as maintenance therapy, especially in older patients, remains unclear. This study aimed to evaluate the efficacy of repeat-dose RTX maintenance therapy regardless of age.

Methods

We retrospectively reviewed the clinical courses of 13 biopsy-proven adult MCD patients receiving RTX and evaluated the relapse rate, concomitant steroid and immunosuppressant use, relationship between B-cell depletion time and relapse, and adverse events.

Results

Mean patient age at start of RTX therapy was 51.5 ± 20.1 years. Each RTX induction consisted of a single 375 mg/m2 dose. One patient received two RTX doses with a 1-year interval. The remaining 12 patients received RTX at 6-month intervals up to four times after RTX introduction. The median observation period was 28 (16–60) months after RTX induction, median relapse frequency was significantly decreased from 0.83 (0.18–1.92) to 0 (0–0.71) times/year (P < 0.001), and median prednisolone dose was reduced from 25 (5–40) mg to 2.5 (0–10) mg (P < 0.001). CD19-positive B cells remained depleted during RTX administration in 6-month intervals. No serious adverse events were observed after RTX administration.

Conclusions

Repeat-dose RTX as maintenance therapy efficiently prevented recurrence and was well tolerated in adult MCD patients including older. This regimen has the potential to maintain prolonged remission. Future studies in larger cohorts are needed to identify the optimal dose and frequency and evaluate the long-term effectiveness and safety of this regimen.

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Acknowledgments

We would like to thank Chugai Pharmaceutical Co., Ltd. for providing drug information.

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Authors and Affiliations

  1. Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8553, Japan

    Shinya Taguchi, Takayasu Ohtake, Yasuhiro Mochida, Kunihiro Ishioka, Hidekazu Moriya, Sumi Hidaka & Shuzo Kobayashi

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  1. Shinya Taguchi
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  2. Takayasu Ohtake
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  3. Yasuhiro Mochida
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  4. Kunihiro Ishioka
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  6. Sumi Hidaka
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  7. Shuzo Kobayashi
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Corresponding author

Correspondence to Shinya Taguchi.

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Disclosure of potential conflicts of interest

This study complied with the standards of the Declaration of Helsinki and was approved by the Ethics Committee for Human Research of Shonan Kamakura General Hospital (approval number: TGE01289-024). All the authors have declared no competing interest.

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Written informed consent for participation was not required because of the retrospective study design but, rather, informed consent was obtained in the form of opt-out on the website.

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Taguchi, S., Ohtake, T., Mochida, Y. et al. Efficacy of repeat-dose rituximab maintenance therapy for minimal change disease in adults. Clin Exp Nephrol 24, 1132–1139 (2020). https://doi.org/10.1007/s10157-020-01943-3

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  • DOI: https://doi.org/10.1007/s10157-020-01943-3

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