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. 2024 Nov;28(11):1082-1089.
doi: 10.1007/s10157-024-02508-4. Epub 2024 Jun 4.

Relapse during and after regular single-dose rituximab treatment in adult patients with steroid-dependent nephrotic syndrome

Eiichiro Saito  1 , Atsushi Oura  1 , Tetsuya Kyo  1 , Shun Ishigaki  1 , Hitomi Kamei  1 , Yuki Nakamura  1 , Jun Soma  1 , Izaya Nakaya  2
Affiliations

Relapse during and after regular single-dose rituximab treatment in adult patients with steroid-dependent nephrotic syndrome

Eiichiro Saito et al. Clin Exp Nephrol. 2024 Nov.

Abstract

Background: Rituximab is widely used in patients with steroid-dependent nephrotic syndrome. However, information on the effect of long-term rituximab treatment is limited. This study examined the efficacy of rituximab during and after treatment in adult patients with steroid-dependent nephrotic syndrome.

Methods: This retrospective cohort study included 30 patients with steroid-dependent nephrotic syndrome. Patients received regular single-dose rituximab (500 mg) intravenously every 6 months. Discontinuation of rituximab was considered after four to six doses if there was no recurrence of nephrotic syndrome. Glucocorticoid discontinuation with remission, first relapse after rituximab initiation, and relapse after regular rituximab treatment discontinuation were evaluated.

Results: The median age was 38 (range 18-67) years. Of 30 patients, 13 and 17 were men and women, respectively. Prior to rituximab treatment, the median number of nephrotic syndrome relapses in the patients was 5 (range 2- > 20). The 1 year discontinuation rate of glucocorticoids with remission was 83%. All patients discontinued glucocorticoid treatment at least once until 3 years and 7 months. The 1 and 2 year relapse rates after initiation of rituximab treatment were 0% and 3%, respectively. 25 patients discontinued regular rituximab treatment after a median number of six (4-12) doses. Six patients relapsed after discontinuing rituximab, and the 1 and 2 year relapse rates after the last regular rituximab treatment were 9% and 25%, respectively.

Conclusion: All patients with steroid-dependent nephrotic syndrome who received rituximab could discontinue glucocorticoid treatment with remission, and three-fourths of the patients remained in remission for > 2 years after discontinuing rituximab treatment.

Keywords: Focal segmental glomerulosclerosis; Glucocorticoid; Minimal change disease; Proteinuria; Remission.

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Conflict of interest statement

Declarations Conflict of interest The authors have declared that no conflict of interest exists. Ethical approval This study was approved by the Ethics Committee of Iwate Prefectural Central Hospital and conducted in accordance with the ethical principles of the Declaration of Helsinki. Informed consent A written informed consent was not obtained from the patients because the ethical guidelines for epidemiological research in Japan do not require informed consent for a retrospective cohort study using only existing medical records.

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