Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 14;18(1):275-278.
doi: 10.5114/aoms/145587. eCollection 2022.

Comparison of rituximab, cyclophosphamide, and tacrolimus as first steroid-sparing agents for complicated relapsing/steroid-dependent nephrotic syndrome in children: an evaluation of the health-related quality of life

Li Wang  1   2 , Jialiang Zhu  1   3 , Mingyun Xia  1   3 , Ran Hua  2 , Fang Deng  1   3
Affiliations

Comparison of rituximab, cyclophosphamide, and tacrolimus as first steroid-sparing agents for complicated relapsing/steroid-dependent nephrotic syndrome in children: an evaluation of the health-related quality of life

Li Wang et al. Arch Med Sci. .

Abstract

Introduction: Frequently-relapsing/steroid-dependent nephrotic syndrome (FRSDNS) leads to steroid toxicity impairing quality of life (QOL), thus prompting the use of steroid-sparing drugs.

Methods: 51 FRSDNS children not previously treated with steroid-sparing agents were randomized to receive rituximab, cyclophosphamide, or tacrolimus. Clinical findings and QOL were evaluated before and after treatment.

Results: The mean relapse rate in all groups declined six months after treatment, however, 1-year relapse-free survival rate, number of relapses, and cumulative prednisolone dosage were lower with rituximab than with tacrolimus and cyclophosphamide. Cyclophosphamide group had twice frequency of infections compared to the other groups. At 1 year after treatment, total scores showed greater improvement with rituximab.

Conclusions: As first-line steroid-sparing agent, rituximab is more effective and safer than cyclophosphamide and tacrolimus in FRSDNS, and improve QOL.

Keywords: cyclophosphamide; frequently relapsing/steroid-dependent nephrotic syndrome; quality of life; rituximab; tacrolimus.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure. 1
Figure. 1
Relapse-free survival during 1-year follow-up comparing patients treated with rituximab, tacrolimus, and cyclophosphamide. The 1-year relapse-free survival was 82.4% with rituximab vs. 64.7% with tacrolimus (adjusted HR = 2.346; 95% CI: 0.586–9.389; p = 0.228) vs. 11.8% with cyclophosphamide (adjusted HR = 5.082; 95% CI: 1.415–18.253; p = 0.013)
See this image and copyright information in PMC

References

    1. Larkins NG, Liu ID, Willis NS, et al. Non-corticosteroid immunosuppressive medications for steroid-sensitive nephrotic syndrome in children. Cochrane Database Syst Rev. 2020;4:CD002290. - PMC - PubMed
    1. Tan L, Li S, Yang H, et al. Efficacy and acceptability of immunosuppressive agents for pediatric frequently-relapsing and steroid-dependent nephrotic syndrome: a network meta-analysis of randomized controlled trials. Medicine. 2019;98:e15927. - PMC - PubMed
    1. Ravani P, Lugani F, Drovandi S, et al. Rituximab vs low-dose mycophenolate mofetil in recurrence of steroid-dependent nephrotic syndrome in children and young adults: a randomized clinical trial. JAMA Pediatr. 2021;175:631–2. - PMC - PubMed
    1. Ahmed HM. Tacrolimus can induce remission in cyclosporine and mycophenolate mofetil resistant pediatric onset nephrotic syndrome. Iran J Kidney Dis. 2019;13:322–7. - PubMed
    1. Sinha A, Bhatia D, Gulati A, et al. Efficacy and safety of rituximab in children with difficult-to-treat nephrotic syndrome. Nephrol Dial Transplant. 2015;30:96–106. - PubMed