Long-term follow-up after rituximab for steroid-dependent idiopathic nephrotic syndrome

In patients with refractory steroid-sensitive nephrotic syndrome (SSNS), treatment with rituximab has shown encouraging results; however, long-term follow-up data are not available. We performed a retrospective analysis of 37 patients (25 boys) with steroid-dependent nephrotic syndrome who were trea...

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Bibliographic Details
Published in:	Nephrology, dialysis, transplantation Vol. 27; no. 5; pp. 1910 - 1915
Main Authors:	KEMPER, Markus J, GELLERMANN, Jutta, POHL, Martin, ROSENTHAL, Katrin, ROSAHL, Anne, MUELLER-WIEFEL, Dirk E, DÖTSCH, Jörg, HABBIG, Sandra, KRMAR, Rafael T, DITTRICH, Katalin, JUNGRAITHMAYR, Therese, PAPE, Lars, PATZER, Ludwig, BILLING, Heiko, WEBER, Lutz
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-05-2012
Subjects:	Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Antibodies, Monoclonal, Murine-Derived - therapeutic use Biological and medical sciences Child Child, Preschool Dose-Response Relationship, Drug Drug Therapy, Combination Emergency and intensive care: renal failure. Dialysis management Female Follow-Up Studies Glomerulonephritis Humans Immunologic Factors - therapeutic use Infant Intensive care medicine Kaplan-Meier Estimate Longitudinal Studies Male Medical sciences Medicin och hälsovetenskap Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Nephrotic Syndrome - drug therapy Recurrence Remission Induction Retrospective Studies Rituximab Steroids - therapeutic use Treatment Outcome Glomerulonephritis Kidney disease Antineoplastic agent Steroid Urinary system disease Hemodialysis Idiopathic Rituximab Nephrotic syndrome Monoclonal antibody Immunomodulator Extrarenal dialysis Renal failure Immunosuppressive agent steroid sensitive
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Summary:	In patients with refractory steroid-sensitive nephrotic syndrome (SSNS), treatment with rituximab has shown encouraging results; however, long-term follow-up data are not available. We performed a retrospective analysis of 37 patients (25 boys) with steroid-dependent nephrotic syndrome who were treated with rituximab (375 mg/m(2) given weekly for one to four courses). Long-term follow-up data (>2 years, median 36, range 24-92.8 months) are available for 29 patients (12 boys). Twenty-six of 37 (70.3%) patients remained in remission after 12 months. Relapses occurred in 24 (64.8%) patients after a median of 9.6 (range 5.2-64.1) months. Time to first relapse was significantly shorter in patients receiving one or two compared to three or four initial infusions. In the 29 patients with long-term follow-up for >2 years, 12 (41%) patients remained in remission after the initial rituximab course for >24 months, 7 (24.1%) patients without further maintenance immunosuppression. Nineteen children received two to four repeated courses of rituximab increasing the total number of patients with long-term remission to 20 (69%), remission including 14 (48%) patients off immunosuppression. The proportion of patients with long-term remission was not related to the number of initial rituximab applications. No serious side effects were noted. Rituximab is an effective treatment option in the short- and long-term control of treatment refractory SSNS. Further controlled studies are needed to address optimal patient selection, dose and safety of rituximab infusions.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0931-0509 1460-2385 1460-2385
DOI:	10.1093/ndt/gfr548