Immunoglobulin Serum Levels in Rituximab-treated Patients with Steroid-dependent Nephrotic Syndrome

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2019 Nov 10

PMID 31705306

Citations 16

Authors

Cyrielle Parmentier

Jean-Daniel Delbet

Stephane Decramer

Olivia Boyer

Julien Hogan

Tim Ulinski

Affiliations

Soon will be listed here.

Abstract

Background: Rituximab (RTX) is efficient in steroid-dependent nephrotic syndrome (SDNS) in pediatric and adult patients. The aim of this study is to describe hypogammaglobulinemia as a side effect of RTX treatment.

Methods: All pediatric patients (< 18 years old) of four French pediatric nephrology centers who received RTX for SDNS between 2010 and 2015 have been included. Clinical and biological data have been analyzed retrospectively before, during, and after RTX treatment. Hypogammaglobulinemia was defined as an IgG level < - 2 standard deviations for patient age.

Results: A total of 107 pediatric patients have been included, 65.9% were boys, median age at nephrotic syndrome diagnosis was 3.1 interquartile range [IQ 2.24-5.45] years and age at RTX introduction was 11.7 [IQ 8.6-14.2] years. Twenty-one patients had hypogammaglobulinemia before the initiation of RTX. Of the patients, 25/86 had at least one hypogammaglobulinemia during B cell depletion or after B cell recovery while IgG levels at initiation were normal with a persisting hypogammaglobulinemia for 13 patients 1 year after B cell recovery. Patients who developed hypogammaglobulinemia were younger at RTX initiation with a median age of 8.2 years [IQ 6.3-12.4]. Among all the 46 patients with hypogammaglobulinemia during follow-up, 13 had a concomitant infection.

Conclusions: Hypogammaglobulinemia is a frequent complication of RTX treatment in younger children treated for SDNS. The use of RTX in children has to be carefully evaluated and their clinical and biological follow-up should be adapted to the age-dependent risk profile for hypogammaglobulinemia.

Citing Articles

A Systematic Review and Meta-analysis of Rituximab-Associated Infections Among Children and Adolescents With Glomerular Disease: Focus on the Risk of Infections.

Pouransiri Z, Assadi F, Mohkam M, Hooman N, Rostami Z, Mazaheri M J Pediatr Pharmacol Ther. 2023; 28(4):308-315.

PMID: 37795285 PMC: 10547046. DOI: 10.5863/1551-6776-28.4.308.

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

Choi N, Min J, Kim J, Kang H, Ahn Y Pediatr Nephrol. 2023; 39(3):771-780.

PMID: 37682369 DOI: 10.1007/s00467-023-06124-4.

Predictive factors of long-term disease remission after rituximab administration in patients with childhood-onset complicated steroid-dependent nephrotic syndrome: a single-center retrospective study.

Ohyama R, Fujinaga S, Sakuraya K, Hirano D, Ito S Clin Exp Nephrol. 2023; 27(10):865-872.

PMID: 37477752 DOI: 10.1007/s10157-023-02374-6.

Rituximab-associated hypogammaglobulinemia in children with idiopathic nephrotic syndrome: results of an ESPN survey.

Zurowska A, Drozynska-Duklas M, Topaloglu R, Bouts A, Boyer O, Shenoy M Pediatr Nephrol. 2023; 38(9):3035-3042.

PMID: 37014530 PMC: 10432325. DOI: 10.1007/s00467-023-05913-1.

Hypogammaglobulinemia, late-onset neutropenia, and infections following rituximab.

Athni T, Barmettler S Ann Allergy Asthma Immunol. 2023; 130(6):699-712.

PMID: 36706910 PMC: 10247428. DOI: 10.1016/j.anai.2023.01.018.

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