Rituximab therapy for adult patients with idiopathic focal segmental glomerulosclerosis
10.3760/cma.j.cn441217-20200803-00105
- VernacularTitle:利妥昔单抗治疗成人原发性局灶性节段性肾小球硬化症的临床分析
- Author:
Yin WANG
1
;
Binfeng YU
;
Liangliang CHEN
;
Yaomin WANG
;
Ying XU
;
Yilin ZHU
;
Jianghua CHEN
;
Fei HAN
Author Information
1. 浙江大学医学院附属第一医院肾脏病中心 浙江大学肾脏病研究所 浙江省肾脏疾病防治技术研究重点实验室，杭州 310003
- Keywords:
Rituximab;
Nephrotic syndrome;
Treatment outcome;
Focal segmental glomerulosclerosis
- From:
Chinese Journal of Nephrology
2021;37(9):705-711
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of rituximab in the treatment of adult primary focal segmental glomerulosclerosis (FSGS).Methods:Adult FSGS patients treated with rituximab in the First Affiliated Hospital of Zhejiang University College of Medicine were retrospectively enrolled. One or two doses of rituximab (375 mg/m 2) were used aiming to achieve B cell depletion (defined as<5 B cells per microliter in peripheral blood) and the interval between the two doses was 2 weeks. The evaluated major outcomes were remission and relapse of nephropathy, and the secondary outcome measures were adverse events and renal outcomes. Results:A total of 14 patients (9 males) were enrolled, among whom 7 cases were steroid-dependent nephrotic syndrome (SDNS) or frequently relapsing nephrotic syndrome (FRNS), 6 cases were steroid-resistant nephrotic syndrome (SRNS) and one patient was new onset FSGS with contraindication to steroid. After treatment with rituximab, 7 patients with SDNS/FRNS achieved complete remission. At 6 months, the daily oral steroid dose reduced significantly compared with the baseline [(33.3±5.2) mg/d vs (6.7±6.6) mg/d, P<0.01]; while one patient still received tacrolimus 1.0 mg/d, the other 6 patients stopped using immunosuppressants; and the total number of relapse/total follow-up months decreased from 0.257 times/month to 0.058 times/month after the use of rituximab. For the other 6 SRNS patients and one patient with contraindication to steroid, three SRNS patients achieved partial remission and one patient with contraindication to steroid achieved complete remission at 34.50(20.25, 95.25) days after use of rituximab, and the other 3 SRNS patients failed to achieve remission, of whom one patient developed end stage renal disease at 23 months. Conclusions:Rituximab may reduce the risk of relapse and help steroid or immunosuppressant-tapering in adult steroid-dependent/frequently relapsing idiopathic FSGS. However, it is not effective in SRNS patients.
