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A Prospective Cohort Study of Rituximab in the Treatment of Refractory Nephrotic Syndrome

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Publisher Springer
Specialty Nephrology
Date 2021 Apr 27
PMID 33905043
Citations 2
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Abstract

Objective: To explore the efficacy and safety of rituximab (RTX) in the treatment of autoimmune nephropathy manifested as refractory nephrotic syndrome (RNS).

Methods: A single-center prospective cohort study was conducted on RNS patients treated with RTX between March 2017 and December 2019. The subjects were divided into the primary nephropathy (PN) group and the secondary nephropathy (SN) group. Based on the estimated glomerular filtration rate (eGFR) before RTX treatment, the SN group was then divided into the SN-1 group (eGFR ≥ 30 ml/min) and the SN-2 group (eGFR < 30 ml/min). Biochemical parameters and clinical data were recorded during follow-up.

Results: Fifty-four patients were followed up for at least 6 months. The overall remission rates were 65%, 66.7%, 27.3% in the PN, SN-1, and SN-2 groups, respectively (P = 0.022). Kaplan-Meier analysis showed a significant difference of the renal survival among the three subgroups (P < 0.001). Multivariate Cox regression analysis showed that eGFR value before treatment was an independent predictor (HR 0.919, 95%CI 0.863-0.979) for renal survival. In terms of adverse events, infection accounted for 56.6%. The incidence of severe infection was 10%, 25% and 50% in PN group, SN-1 group and SN-2 group, respectively.

Conclusions: RTX may be a promising option in RNS patients with eGFR ≥ 30 ml/min/1.73m. However, it has little effect on prognosis in patients with secondary RNS with eGFR < 30 ml/min/1.73m, but with a high risk of severe infection.

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Efficacy and Safety of Mizoribine for the Treatment of Refractory Nephrotic Syndrome: Protocol for a Multicenter, Controlled, Open-label, Randomized Controlled Trial.

Dong Z, Zhou J, Xu Z, Ni Z, He Y, Lin H JMIR Res Protoc. 2023; 12:e46101.

PMID: 36990111 PMC: 10337463. DOI: 10.2196/46101.


Rituximab Dosing in Glomerular Diseases: A Scoping Review.

Alzayer H, Sebastian K, OShaughnessy M Can J Kidney Health Dis. 2022; 9:20543581221129959.

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References
1.
Moroni G, Depetri F, Del Vecchio L, Gallelli B, Raffiotta F, Giglio E . Low-dose rituximab is poorly effective in patients with primary membranous nephropathy. Nephrol Dial Transplant. 2016; 32(10):1691-1696. DOI: 10.1093/ndt/gfw251. View

2.
Melander C, Sallee M, Trolliet P, Candon S, Belenfant X, Daugas E . Rituximab in severe lupus nephritis: early B-cell depletion affects long-term renal outcome. Clin J Am Soc Nephrol. 2009; 4(3):579-87. PMC: 2653670. DOI: 10.2215/CJN.04030808. View

3.
Davies R, Sangle S, Jordan N, Aslam L, Lewis M, Wedgwood R . Rituximab in the treatment of resistant lupus nephritis: therapy failure in rapidly progressive crescentic lupus nephritis. Lupus. 2013; 22(6):574-82. DOI: 10.1177/0961203313483376. View

4.
van den Brand J, Ruggenenti P, Chianca A, Hofstra J, Perna A, Ruggiero B . Safety of Rituximab Compared with Steroids and Cyclophosphamide for Idiopathic Membranous Nephropathy. J Am Soc Nephrol. 2017; 28(9):2729-2737. PMC: 5576929. DOI: 10.1681/ASN.2016091022. View

5.
Trivin C, Tran A, Moulin B, Choukroun G, Gatault P, Courivaud C . Infectious complications of a rituximab-based immunosuppressive regimen in patients with glomerular disease. Clin Kidney J. 2017; 10(4):461-469. PMC: 5570029. DOI: 10.1093/ckj/sfw101. View