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Review
. 2025 Aug 13.
doi: 10.1007/s12519-025-00957-9. Online ahead of print.

Clinical practice guidelines for rituximab treatment in children with steroid-sensitive nephrotic syndrome

Qian Shen  1   2 , Zheng-Kun Xia  3 , Jia-Lu Liu  1   2 , Lei-Lin Shao  1   2 , Qiu-Xia Chen  4 , Hui-Shan Wang  5 , Ying Shen  6 , Jian-Hua Mao  7 , Xiao-Yun Jiang  8 , Cui-Hua Liu  9 , Xiao-Shan Shao  10 , Xiao-Wen Wang  11 , Xia Gao  12 , Chong-Fan Zhang  13 , Ai-Hua Zhang  14 , Hong Xu  15   16 ; Working Group on Clinical Practice Guidelines for the Rituximab Treatment in Children with Steroid-sensitive Nephrotic Syndrome
Affiliations
Review

Clinical practice guidelines for rituximab treatment in children with steroid-sensitive nephrotic syndrome

Qian Shen et al. World J Pediatr. .

Abstract

Background: Steroid-sensitive nephrotic syndrome is a prevalent glomerular disease in children. The 2021 guidelines for glomerular disease management by Kidney Disease: Improving Global Outcomes and the 2023 recommendations for steroid-sensitive nephrotic syndrome management by International Pediatric Nephrology Association recommend rituximab for frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome in children. However, there is considerable variation in rituximab application, including administration timing, dose, frequency, concomitant medications, and follow-up schedules. In addition, rituximab use for nephrotic syndrome remains off-label in most countries.

Data sources: The "Pediatric Nephrology Committee of the Chinese Medical Doctor Association", the "Pediatric Nephrology Society of the Chinese Medical Association", and the "Fudan University GRADE Center" collaborated to develop a clinical practice guideline for rituximab in pediatric steroid-sensitive nephrotic syndrome. Databases and starting/ending time for retrieval were as follows. Databases in English: PubMed, Embase, Cochrane, and Scopus; database in Chinese: Chinese Biomedical Literature Service provided by SinoMed. The publication dates were limited to those from 2004 to June 26, 2022.

Results: Through systematic reviews and meta-analyses covering nine clinically relevant patient or population covered, intervention, comparator, and outcome questions, seven recommendations were formulated and formally graded according to these guidelines.

Conclusions: This guideline aspires to serve as a pivotal resource for healthcare providers, offering guidance on administration timing, dosage, frequency, concomitant medications, and follow-up protocols.

Keywords: Guidelines; Pediatrics; Rituximab; Steroid-sensitive nephrotic syndrome.

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Conflict of interest statement

Declarations. Conflict of interest: The Working Group members and the Evidence-to-Decision (EtD) experts of the RTX Guidelines have all signed the Conflict-of-Interest Declaration. The Working Group consists of nephrologists from the Children’s Hospital of Fudan University and Children’s Hospital of Nanjing Medical University, who voluntarily participated in working group meetings, literature retrieval & screening, evidence extraction, bias risk assessment, and systematic review/meta-analysis, all for free. The Methodology Team is from Fudan University GRADE Center and volunteers to provide support and training for the methodologies used in the guideline preparation. The EtD meetings were offline, and funded by the research project titled “The Efficacy and Safety of Rituximab in Reducing Relapse of Steroid-sensitive Nephrotic Syndrome in Children: A Single-Arm, Open-Label, Multicenter Clinical Study”. The review of the manuscripts was by unpaid experts through correspondence. Author Hong Xu, Jian-Hua Mao, and Ai-Hua Zhang are members of the Editorial Board for World Journal of Pediatrics. They were not involved in the peer-review process or the decision to accept this manuscript for publication. The paper was handled by other Editors and has undergone rigorous peer-review process. Ethical approval: Not required. Consent to participate: No patients participated in this study. However, parents of pediatric nephrotic syndrome patients and social workers, who were adequately informed and equipped with necessary decision support, actively engaged in the Evidence-to-Decision (EtD) meeting for the formulation of recommendations.

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References

    1. Nephrology Expert Panel of the Peking University Health Science Center. Expert consensus on the application of rituximab in the treatment of membranous nephropathy. Zhonghua Nei Ke Za Zhi. 2022;61:282–90.
    1. Chinese Society of Nephrology. Expert consensus on the use of rituximab in glomerulonephritis. Chin J Nephrol. 2022;61:151–60.
    1. Common Terminology Criteria for Adverse Events v3. 0 CTCAE. 2006. https://ctep.cancer .gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf. Accessed 31 March 2003.
    1. Jolliff CR, Cost KM, Stivrins PC, Grossman PP, Nolte CR, Franco SM, et al. Reference intervals for serum IgG, IgA, IgM, C3, and C4 as determined by rate nephelometry. Clin Chem. 1982;28:126–8. - PubMed
    1. Chinese Society of Hematology RBCDASG. Chinese expert consensus on the diagnosis and treatment of neutropenia. Natl Med J China. 2022;45:3167–73.

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