Effect of single-dose rituximab on steroid-dependent minimal-change nephrotic syndrome in adults

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2013-05, Vol.28 (5), p.1225-1232
• Main Authors: Takei, Takashi, Itabashi, Mitsuyo, Moriyama, Takahito, Kojima, Chiari, Shiohira, Syunji, Shimizu, Ari, Tsuruta, Yuki, Ochi, Ayami, Amemiya, Nobuyuki, Mochizuki, Toshio, Uchida, Keiko, Tsuchiya, Ken, Nitta, Kosaku
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Immunologic Factors - therapeutic use; Male; Nephrosis, Lipoid - drug therapy; Prednisolone - therapeutic use; Prognosis; Prospective Studies; Recurrence; Remission Induction; Rituximab
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfs515

Steroid-dependent minimal-change nephrotic syndrome (MCNS) requires administration of prolonged courses of prednisolone (PSL); therefore, a paradigm shift from such toxic 'non-specific' therapies to selective immunomodulating regimens is necessary for these cases. To assess the therapeutic effects of rituximab (an anti-CD20 antibody) in adult patients with steroid-dependent MCNS, we performed a prospective trial of the effects of a single dose of rituximab administered twice at an interval of 6 months in 25 MCNS patients. We evaluated the biochemical parameters and compared the clinical findings between the 12-month period before and 12-month period after the first rituximab infusion. A significant reduction in the number of relapses and the total dose and the maintenance dose of PSL administered was observed during the 12-month period after the first rituximab infusion when compared with the findings during the 12-month period before the first rituximab infusion [25 (100%) versus 4 (16%), P < 0.001; 8.2 versus 3.3 g, P < 0.001; 26.4 mg/day at baseline versus 1.1 mg/day at 12-month, P < 0.0001]. Complete remission was achieved/maintained in all patients undergoing B-cell depletion. Four of 17 patients with B-cell repletion developed relapse. Our results revealed that rituximab therapy was associated with a reduction in the number of relapses and in the total dose of PSL needed. Therefore, rituximab appears to be a useful therapeutic agent for adult patients with steroid-dependent MCNS. These results suggest that this treatment is rational and should be considered as an important option in the management of adult patients with steroid-dependent MCNS.