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Nephrol Dial Transplant. 2014 Nov;29(11):2084-91. doi: 10.1093/ndt/gfu209. Epub 2014 Jun 11.

Rituximab for minimal-change nephrotic syndrome in adulthood: predictive factors for response, long-term outcomes and tolerance.

Author information

1
Département de Néphrologie et Transplantation d'organes, CHU Rangueil, Toulouse, France.
2
Service de Néphrologie et Transplantation rénale, CHU Hôtel-Dieu, Nantes, France.
3
Service de Néphrologie, CHU Necker Enfants Malades, AP-HP, Paris, France.
4
Service de Néphrologie et Transplantation, CHU Bichat, AP-HP, Paris, France.
5
Service de Néphrologie, CHU de Pontchaillou, Rennes, France.
6
Service de Néphrologie Pédiatrique, CHU Dupuytren, Limoges, France.
7
Service de Néphrologie, Centre Hospitalier Annecy - Genevois, Annecy, France.
8
Service de Néphrologie, CHU Amiens-Picardie, Amiens, France.
9
Service de Néphrologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique.
10
Service de Néphrologie, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France.
11
Service de Néphrologie, CHU Pellegrin, Bordeaux, France.
12
Service de Néphrologie et Transplantation rénale, CHU Pasteur, Nice, France.

Abstract

BACKGROUND:

Minimal-change nephrotic syndrome (MCNS) is a common cause of steroid sensitive nephrotic syndrome (NS) with frequent relapse. Although steroids and calcineurin inhibitors (CNIs) are the cornerstone treatments, the use of rituximab (RTX), a monoclonal antibody targeting B cells, is an efficient and safe alternative in childhood.

METHODS:

Because data from adults remain sparse, we conducted a large retrospective and multicentric study that included 41 adults with MCNS and receiving RTX.

RESULTS:

Complete (NS remission and withdrawal of all immunosuppressants) and partial (NS remission and withdrawal of at least one immunosuppressants) clinical responses were obtained for 25 and 7 patients, respectively (overall response 78%), including 3 patients that only received RTX and had a complete clinical response. After a follow-up time of 39 months (6-71), relapses occurred in 18 responder patients [56%, median time 18 months (3-36)]. Seventeen of these received a second course of RTX and then had a complete (n = 13) or partial (n = 4) clinical response. From multivariate analysis, on-going mycophenolate mofetil (MMF) therapy at the time of RTX was the only predictive factor for RTX failure [HR = 0.07 95% CI (0.01-0.04), P = 0.003]. Interestingly, nine patients were still in remission at 14 months (3-36) after B-cell recovery. No significant early or late adverse event occurred after RTX therapy.

CONCLUSIONS:

RTX is safe and effective in adult patients with MCNS and could be an alternative to steroids or CNIs in patients with a long history of relapsing MCNS.

KEYWORDS:

B-cells; minimal-change disease; nephrotic syndrome; rituximab; steroids

PMID:
24920841
DOI:
10.1093/ndt/gfu209
[Indexed for MEDLINE]

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