Effective treatment with rituximab for the maintenance of remission in frequently relapsing minimal change disease

Nephrology (Carlton). 2016 Oct;21(10):893-900. doi: 10.1111/nep.12744.

Abstract

Aim: Treatment of frequently relapsing or steroid-dependent minimal change disease (MCD) in children and adults remains challenging. Glucocorticoids and/or other immunosuppressive agents are the mainstay of treatment, but patients often experience toxicity from prolonged exposure and may either become treatment dependent and/or resistant. Increasing evidence suggests that rituximab (RTX) can be a useful alternative to standard immunosuppression and allow withdrawal of maintenance immunosuppressants; however, data on optimal treatment regimens, long-term efficacy and safety are still limited.

Methods: We undertook a prospective study of RTX to allow immunosuppression minimization in 15 young adults with frequently relapsing or steroid-dependent, biopsy-proven MCD. All patients were in remission at the start of treatment and on a calcineurin inhibitor. Two doses of RTX (1 gr) were given 6 months apart. A subset of patients also received an additional dose 12 months later, in order to examine the benefit of re-treatment. Biochemical and clinical parameters were monitored over an extended follow-up period of up to 43 months.

Results: Median steroid-free survival after RTX was 25 months (range 4-34). Mean relapse frequency decreased from 2.60 ± 0.28 to 0.4 ± 0.19 (P < 0.001) after RTX. Seven relapses occurred, five of which (71%) when CD19 counts were greater than 100 µ. Immunoglobulin levels remained unchanged, and no major side effects were observed throughout the follow-up period.

Conclusions: Rituximab therapy is effective at maintaining prolonged steroid-free remission and reducing relapse frequency in this group of patients. Our study lends further support for the role of RTX in the treatment of patients with frequently relapsing or steroid-dependent MCD.

Keywords: calcineurin inhibitor; glucocorticoid; minimal change disease; nephrotic syndrome; rituximab.

MeSH terms

  • Adolescent
  • Adult
  • Calcineurin Inhibitors* / administration & dosage
  • Calcineurin Inhibitors* / adverse effects
  • Drug Administration Schedule
  • Drug Monitoring / methods
  • Female
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects
  • Male
  • Middle Aged
  • Nephrosis, Lipoid* / diagnosis
  • Nephrosis, Lipoid* / physiopathology
  • Nephrosis, Lipoid* / therapy
  • Outcome and Process Assessment, Health Care
  • Prospective Studies
  • Remission Induction / methods
  • Rituximab* / administration & dosage
  • Rituximab* / adverse effects
  • Secondary Prevention / methods
  • Secondary Prevention / statistics & numerical data
  • United Kingdom

Substances

  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Rituximab