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. 2025 Apr 1;36(4):668-678.
doi: 10.1681/ASN.0000000520. Epub 2024 Oct 16.

Long-Term Outcomes of Rituximab-Treated Adult Patients with Podocytopathies

Philipp Gauckler  1 , Anna Matyjek  1   2   3 , Seleni Kapsia  4 , Smaragdi Marinaki  4 , Luis F Quintana  5 , Montserrat M Diaz  6 , Catherine King  7 , Siân Griffin  8 , Raja Ramachandran  9 , Balazs Odler  10 , Kathrin Eller  10 , Ayşe Serra Artan  11 , Safak Mirioglu  11 , Martin Busch  12 , Maxi Schaepe  12 , Kultigin Turkmen  13 , Chee Kay Cheung  14   15 , Ruth J Pepper  16 , Gema Fernandez Juarez  17 , Julio Pascual  18 , Pilar Auñón  18 , Clara García-Carro  19 , Antolina Rodriguez  19 , Federico Alberici  20   21 , Leonella Luzardo  22 , Natalia Chebotareva  23 , Ulf Schönermarck  24 , Loreto Fernández  25 , Jai Radhakrishnan  26 , Karina Guaman  26 , Yonatan Peleg  26 , Léa Hoisnard  27   28   29 , Vincent Audard  30 , Marios Papasotiriou  31 , Nina Krnanska  32 , Vladimir Tesar  32 , Zdenka Hruskova  32 , Annette Bruchfeld  33   34 , Maria Stangou  35 , Georgios Lioulios  35 , Stanislas Faguer  36   37 , David Ribes  36 , Sofiane Salhi  36 , Martin Windpessl  38 , Krešimir Galešić  39   40 , Matija Crnogorac  39 , Nikola Zagorec  39   41 , Gert Mayer  1 , Andreas Kronbichler  1 ; RITERM Study Team
Affiliations

Long-Term Outcomes of Rituximab-Treated Adult Patients with Podocytopathies

Philipp Gauckler et al. J Am Soc Nephrol. .

Abstract

Key Points:

  1. Fifty-five percent of patients achieve long-term remission after rituximab treatment. This is influenced by maintenance therapy with rituximab.

  2. A substantial reduction of annualized relapse rate and concomitant immunosuppression was observed after rituximab treatment.

Background: Long-term outcomes of rituximab-treated adult patients with podocytopathies (either minimal change disease or FSGS) are largely unknown.

Methods: A retrospective study at 30 nephrology departments from 15 countries worldwide included rituximab-treated adults with primary podocytopathies and a minimum clinical follow-up of 36 months. The primary outcome was relapse-free survival at 36 months.

Results: One hundred eighty-three adult patients (n=64 with FSGS and n=119 with minimal change disease) with difficult-to-treat nephrotic syndrome (68% steroid-dependent/frequently relapsing, 22% steroid-resistant, 85% previously treated with two or more lines of immunosuppressive therapy) were treated with rituximab as part of a remission induction regimen. Complete or partial remission at 6 months after rituximab treatment was achieved in 82%. Eighty-three of 151 (55%) initial responders achieved long-term relapse-free survival over 3 years. Maintenance therapy with rituximab was associated with a better relapse-free survival (hazard ratio, 2.05; 95% confidence interval [CI], 1.07 to 3.91), irrespective of the dosing regimen. At 36 months, 61% of initial responders receiving maintenance therapy with rituximab achieved long-term relapse-free survival and withdrawal of all concomitant immunosuppressive medication compared with 36% of patients without maintenance treatment (odds ratio, 2.69; 95% CI, 1.27 to 5.73). Relapses per year were reduced from an annual relapse rate of 1.0 (95% CI, 1.0 to 1.7) before to 0.17 (95% CI, 0.00 to 0.24) relapses per year after rituximab initiation. Over the 36 months of follow-up, a stable course of eGFR was observed in those who initially responded with either complete or partial remission, whereas nonresponders experienced a reduction in eGFR reaching −11 (95% CI, −18 to −8) ml/min per 1.73 m2.

Conclusions: Rituximab facilitated achievement of initial and long-term response in a majority of adult patients with difficult-to-treat podocytopathies. Maintenance treatment with rituximab was further associated with long-term relapse-free survival over 3 years. Nonresponse to initial rituximab treatment was associated with poor kidney prognosis.

Trial registration: ClinicalTrials.gov NCT03970577.

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/JSN/E918.

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