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Efficacy and safety of long-term repeated use of rituximab in pediatric patients with nephrotic syndrome

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A Letter to the Editors to this article was published on 11 April 2024

A Letter to the Editors to this article was published on 20 September 2023

Abstract

Background

We aimed to investigate the efficacy and safety of repeated use of rituximab (RTX) in pediatric patients with nephrotic syndrome (NS).

Methods

Retrospective review of 50 patients with steroid-dependent NS (SDNS) who had received more than three cycles of RTX was conducted; each consisted of one to four infusions until B lymphocytes were depleted.

Results

The median age of starting the first RTX cycle was 12.4 years (interquartile ranges (IQR) 10.2–14.6). During a median follow-up period of 6.3 (IQR 3.6–8.6) years, patients received a median of 5.0 RTX cycles (IQR 4.0–7.3). The number of relapses decreased from a median of 2.0 relapses per year (IQR 1.0–3.0) to 0.2 relapses per year (IQR 0.0–0.5) after long-term RTX treatments (P < 0.001). Longer relapse-free periods were associated with more than four RTX cycles, longer B-cell depletion, older age at each RTX treatment, and lower cholesterol levels. B lymphocytes recovered to 1% at a median of 5.9 months (95% confidence interval 5.7–6.1) after RTX administration. Factors related to a longer period of B-cell depletion included more than five RTX cycles, a higher dose of RTX, older age at treatment, and concurrent use of antimetabolites. During repeated RTX treatments, 8.0%, 6.0%, and 2.0% of patients developed hypogammaglobulinemia, severe infection, and severe neutropenia, respectively.

Conclusions

Long-term repeated use of RTX may be effective and safe in pediatric NS patients. Furthermore, the redosing of RTX could be chosen by considering predictive factors for relapse-free and B-cell depletion periods.

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Data availability

The data underlying this article will be shared upon reasonable request to the corresponding author.

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Acknowledgements

The authors thank all the contributors to this work.

Funding

This work was supported by the New Faculty Startup Fund from Seoul National University.

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Authors and Affiliations

  1. Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Republic of Korea

    Naye Choi, Hee Gyung Kang & Yo Han Ahn

  2. Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea

    Naye Choi, Jeesu Min, Ji Hyun Kim, Hee Gyung Kang & Yo Han Ahn

  3. Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Republic of Korea

    Jeesu Min

  4. Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Ji Hyun Kim

  5. Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea

    Hee Gyung Kang & Yo Han Ahn

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Naye Choi and Yo Han Ahn. The first draft of the manuscript was written by Naye Choi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yo Han Ahn.

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This study was approved by the Seoul National University Hospital Institutional Review Board (IRB no. 2106–195-1231).

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Choi, N., Min, J., Kim, J.H. et al. Efficacy and safety of long-term repeated use of rituximab in pediatric patients with nephrotic syndrome. Pediatr Nephrol 39, 771–780 (2024). https://doi.org/10.1007/s00467-023-06124-4

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  • DOI: https://doi.org/10.1007/s00467-023-06124-4

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