TY - JOUR
T1 - Therapeutic efficacy of rituximab for the management of adult-onset steroid-dependent nephrotic syndrome
T2 - a retrospective study
AU - Katsuno, Takayuki
AU - Masuda, Tomohiro
AU - Saito, Shoji
AU - Kato, Noritoshi
AU - Ishimoto, Takuji
AU - Kato, Sawako
AU - Kosugi, Tomoki
AU - Tsuboi, Naotake
AU - Kitamura, Hiroshi
AU - Tsuzuki, Toyonori
AU - Ito, Yasuhiko
AU - Maruyama, Shoichi
N1 - Funding Information:
Acknowledgements This study was supported partly by a Grant-in-Aid for Progressive Renal Diseases Research, and Research on Rare and Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.
Funding Information:
Co., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Limited., and Torii Pharmaceutical Co., Ltd. The Department of Nephrology, Nagoya University Graduate School of Medicine received research promotion grants from Astellas Pharma Inc., Bristol-Myers Squibb., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical Co., Ltd., MSD K.K., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Limited., Torii Pharmaceutical Co., Ltd., and Sumitomo Dainippon Pharma Co., Ltd.
Publisher Copyright:
© 2018, Japanese Society of Nephrology.
PY - 2019/2/15
Y1 - 2019/2/15
N2 - Background: Recent reports have described the efficacy of rituximab in treating steroid-dependent nephrotic syndrome (SDNS) in pediatric patients. However, few reports describe data regarding adult-onset SDNS. We investigated the efficacy of rituximab for the management of adult-onset SDNS. Methods: We performed a retrospective cohort study investigating eight patients with adult-onset SDNS who were treated with rituximab. Clinical data were obtained at the initiation of rituximab therapy. The primary outcomes evaluated were successful suppression of relapses and CD19+ cells after rituximab treatment. The corticosteroid- and immunosuppressant-sparing effect and adverse events were additionally evaluated. Results: All eight patients were diagnosed with minimal change nephrotic syndrome and received immunosuppressants in addition to corticosteroid. Total number of relapses was 10.5 times as a median value. Rituximab administration was repeated in two patients, whereas six received single-dose rituximab. Three of eight (37.5%) patients showed relapse after rituximab therapy. A rituximab-induced depletion in CD19+ cells noted initially was followed by their reappearance in all patients. There were cases with no relapse after the reappearance of CD19+ cells. The median relapse time pre- and post-rituximab therapy showed a decrease from 1 time/year (interquartile range [IQR] 1–3 times/year) to 0 time/year (IQR 0–1 time/year). Rituximab treatment induced a significant reduction in the required doses of corticosteroid and cyclosporine (P < 0.01). No serious adverse events were observed. Conclusion: Rituximab treatment was effective not only in childhood-onset but also in adult-onset SDNS. Further studies are needed to establish optimal treatment regimens.
AB - Background: Recent reports have described the efficacy of rituximab in treating steroid-dependent nephrotic syndrome (SDNS) in pediatric patients. However, few reports describe data regarding adult-onset SDNS. We investigated the efficacy of rituximab for the management of adult-onset SDNS. Methods: We performed a retrospective cohort study investigating eight patients with adult-onset SDNS who were treated with rituximab. Clinical data were obtained at the initiation of rituximab therapy. The primary outcomes evaluated were successful suppression of relapses and CD19+ cells after rituximab treatment. The corticosteroid- and immunosuppressant-sparing effect and adverse events were additionally evaluated. Results: All eight patients were diagnosed with minimal change nephrotic syndrome and received immunosuppressants in addition to corticosteroid. Total number of relapses was 10.5 times as a median value. Rituximab administration was repeated in two patients, whereas six received single-dose rituximab. Three of eight (37.5%) patients showed relapse after rituximab therapy. A rituximab-induced depletion in CD19+ cells noted initially was followed by their reappearance in all patients. There were cases with no relapse after the reappearance of CD19+ cells. The median relapse time pre- and post-rituximab therapy showed a decrease from 1 time/year (interquartile range [IQR] 1–3 times/year) to 0 time/year (IQR 0–1 time/year). Rituximab treatment induced a significant reduction in the required doses of corticosteroid and cyclosporine (P < 0.01). No serious adverse events were observed. Conclusion: Rituximab treatment was effective not only in childhood-onset but also in adult-onset SDNS. Further studies are needed to establish optimal treatment regimens.
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U2 - 10.1007/s10157-018-1630-y
DO - 10.1007/s10157-018-1630-y
M3 - Article
C2 - 30121802
AN - SCOPUS:85051813240
VL - 23
SP - 207
EP - 214
JO - Clinical and Experimental Nephrology
JF - Clinical and Experimental Nephrology
SN - 1342-1751
IS - 2
ER -