1. Rituximab treatment for difficult-to-treat nephrotic syndrome in children: a multicenter, retrospective study
- Author
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Taşdemir, Mehmet; Bilge, İlmay (ORCID 0000-0002-4852-989X & YÖK ID 198907), Canpolat, N.; Yıldız, N.; Özçelik, G.; Benzer, M.; Saygılı, S.K; Özkayin, E.N.; Türkkan, Ö.N.; Balat, A.; Candan, C.; Çelakıl, M.; Yavuz, S.; Akıncı, N.; Göknar, N.; Akgün, C.; Tülpar, S.; Alpay, H.; Sever, F.L., Taşdemir, Mehmet; Bilge, İlmay (ORCID 0000-0002-4852-989X & YÖK ID 198907), and Canpolat, N.; Yıldız, N.; Özçelik, G.; Benzer, M.; Saygılı, S.K; Özkayin, E.N.; Türkkan, Ö.N.; Balat, A.; Candan, C.; Çelakıl, M.; Yavuz, S.; Akıncı, N.; Göknar, N.; Akgün, C.; Tülpar, S.; Alpay, H.; Sever, F.L.
- Abstract
Background/aim: this study aimed to evaluate the efficacy of rituximab in children with difficult-to-treat nephrotic syndrome, considering the type of disease (steroid-sensitive or -resistant) and the dosing regimen. Materials and methods: this multicenter retrospective study enrolled children with difficult-to-treat nephrotic syndrome on rituximab treatment from 13 centers. The patients were classified based on low (single dose of 375 mg/m(2)) or high (2-4 doses of 375 mg/m(2)) initial dose of rituximab and the steroid response. Clinical outcomes were compared. Results: data from 42 children [20 steroid-sensitive (frequent relapsing / steroid-dependent) and 22 steroid-resistant nephrotic syndrome, aged 1.9-17.3 years] were analyzed. Eleven patients with steroid-sensitive nephrotic syndrome (55%) had a relapse following initial rituximab therapy, with the mean time to first relapse of 8.4 +/- 5.2 months. Complete remission was achieved in 41% and 36% of steroid-resistant patients, with the median remission time of 3.65 months. At Year 2, eight patients in steroid-sensitive group (40%) and four in steroid-resistant group (18%) were drug-free. Total cumulative doses of rituximab were higher in steroid-resistant group (p = 001). Relapse rates and time to first relapse in steroid-sensitive group or remission rates in steroid-resistant group did not differ between the low and high initial dose groups. Conclusion: the current study reveals that rituximab therapy may provide a lower relapse rate and prolonged relapse-free survival in the steroid-sensitive group, increased remission rates in the steroid-resistant group, and a significant number of drug-free patients in both groups. The optimal regimen for initial treatment and maintenance needs to be determined.
- Published
- 2021