Efficacy of Semiannual Single Fixed Low-Dose Rituximab Therapy in Steroid-Dependent Minimal Change Nephrotic Syndrome: A Case Series

Overview

Journal Case Rep Nephrol Dial

Specialty Nephrology

Date 2018 Nov 28

PMID 30479998

Citations 1

Authors

Ryosuke Usui

Yohei Tsuchiya

Kosaku Nitta

Minako Koike

Affiliations

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Abstract

The frequency of using rituximab to treat refractory nephrotic syndrome has recently been increasing, and the conventional dose of rituximab used to treat it, 375 mg/m body surface area once weekly for 4 weeks, has been modelled on the chemotherapy regimen for B-cell non-Hodgkin's lymphoma. The dose and intervals of rituximab in refractory nephrotic syndrome remain controversial. Clear lymphoma cell hyperplasia is seen in lymphoma patients, but not in nephrotic syndrome patients. Since we thought that it might be possible to reduce the dose of rituximab if only used for the purpose of depleting CD20-positive B cells in nephrotic patients' peripheral blood, we tried semiannually with a single fixed rituximab dose of 100 mg/body, and a complete remission was attained in 3 cases without treatment with prednisolone or cyclosporine. Our report strongly suggests considering appropriate dose and interval of rituximab therapy in the treatment of steroid-dependent nephrotic syndrome.

Citing Articles

Monthly mini-dose rituximab for primary anti-PLA2R-positive membranous nephropathy: a personalized approach.

Wang S, Deng Z, Wang Y, Bao W, Zhou S, Cui Z BMC Nephrol. 2023; 24(1):146.

PMID: 37237260 PMC: 10213597. DOI: 10.1186/s12882-023-03206-1.

References

Kamei K, Ito S, Nozu K, Fujinaga S, Nakayama M, Sako M . Single dose of rituximab for refractory steroid-dependent nephrotic syndrome in children. Pediatr Nephrol. 2009; 24(7):1321-8. DOI: 10.1007/s00467-009-1191-0. View

Maloney D, Grillo-Lopez A, Bodkin D, White C, Liles T, Royston I . IDEC-C2B8: results of a phase I multiple-dose trial in patients with relapsed non-Hodgkin's lymphoma. J Clin Oncol. 1997; 15(10):3266-74. DOI: 10.1200/JCO.1997.15.10.3266. View

Kurosu N, Sugiura H, Iwasaki C, Asamiya Y, Kojima C, Moriyama T . Successful use of single-dose rituximab for the maintenance of remission in a patient with steroid-resistant nephrotic syndrome. Intern Med. 2009; 48(21):1901-4. DOI: 10.2169/internalmedicine.48.2435. View

Takei T, Itabashi M, Moriyama T, Kojima C, Shiohira S, Shimizu A . Effect of single-dose rituximab on steroid-dependent minimal-change nephrotic syndrome in adults. Nephrol Dial Transplant. 2012; 28(5):1225-32. DOI: 10.1093/ndt/gfs515. View

Wong C . Rituximab in refractory antineutrophil cytoplasmic antibody-associated vasculitis: what is the current evidence?. Nephrol Dial Transplant. 2006; 22(1):32-6. DOI: 10.1093/ndt/gfl573. View

Sugiura H, Takei T, Itabashi M, Tsukada M, Moriyama T, Kojima C . Effect of single-dose rituximab on primary glomerular diseases. Nephron Clin Pract. 2010; 117(2):c98-105. DOI: 10.1159/000319656. View

Takei T, Koike M, Suzuki K, Shirota S, Itabashi M, Ohtsubo S . The characteristics of relapse in adult-onset minimal-change nephrotic syndrome. Clin Exp Nephrol. 2007; 11(3):214-217. DOI: 10.1007/s10157-007-0484-5. View

Miyabe Y, Takei T, Iwabuchi Y, Moriyama T, Nitta K . Amelioration of the adverse effects of prednisolone by rituximab treatment in adults with steroid-dependent minimal-change nephrotic syndrome. Clin Exp Nephrol. 2015; 20(1):103-10. DOI: 10.1007/s10157-015-1139-6. View

Godeau B . B-cell depletion in immune thrombocytopenia. Semin Hematol. 2013; 50 Suppl 1:S75-82. DOI: 10.1053/j.seminhematol.2013.03.014. View

10.

Guigonis V, Dallocchio A, Baudouin V, Dehennault M, Hachon-LE Camus C, Afanetti M . Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases. Pediatr Nephrol. 2008; 23(8):1269-79. DOI: 10.1007/s00467-008-0814-1. View

11.

Bagga A, Sinha A, Moudgil A . Rituximab in patients with the steroid-resistant nephrotic syndrome. N Engl J Med. 2007; 356(26):2751-2. DOI: 10.1056/NEJMc063706. View

12.

Plosker G, Figgitt D . Rituximab: a review of its use in non-Hodgkin's lymphoma and chronic lymphocytic leukaemia. Drugs. 2003; 63(8):803-43. DOI: 10.2165/00003495-200363080-00005. View

13.

Chaumais M, Garnier A, Chalard F, Peuchmaur M, Dauger S, Jacqz-Agrain E . Fatal pulmonary fibrosis after rituximab administration. Pediatr Nephrol. 2009; 24(9):1753-5. DOI: 10.1007/s00467-009-1195-9. View

14.

Fujimoto S, Yamamoto Y, Hisanaga S, Morita S, Eto T, Tanaka K . Minimal change nephrotic syndrome in adults: response to corticosteroid therapy and frequency of relapse. Am J Kidney Dis. 1991; 17(6):687-92. DOI: 10.1016/s0272-6386(12)80353-2. View

15.

Iijima K, Sako M, Nozu K, Mori R, Tuchida N, Kamei K . 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(9950):1273-81. DOI: 10.1016/S0140-6736(14)60541-9. View