Rituximab treatment for refractory nephrotic syndrome in adults: a multicenter retrospective study

Ren Fail. 2023 Dec;45(1):2237124. doi: 10.1080/0886022X.2023.2237124.

Abstract

Background: The treatment of refractory nephrotic syndrome (RNS) is full of challenges and the role of rituximab (RTX) is not well-established, thus this study aims to demonstrate the role of RTX in RNS.

Methods: This was a multicenter retrospective study of all adult patients receiving RTX for RNS. Patients enrolled were divided into two groups according to pathological pattern: 20 patients as a group of podocytopathy (including minimal change disease [MCD] and focal and segmental glomerulosclerosis [FSGS]), and 26 patients as membranous nephropathy (MN) group. The remission rate, relapse rate, adverse effects, and predictors of remission were analyzed.

Results: A total of 75 patients received RTX for RNS and 48 were available for analysis after exclusion criteria. No significant difference in the remission rate at 6 or 12 months was observed between the MCD/FSGS and MN cases (p > 0.05). The median duration of the first complete remission (CR) was 1 month in the podocytopathy group and 12.5 months in the MN group. Three relapses were associated with infection as the ultimate outcome, and 6 out of 48 remained refractory representing a response rate of 87.5% in RNS. Clinical predictors of cumulative CR were estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and mean arterial pressure (MAP) ≤103 mmHg at the beginning of therapy in patients with MN. No serious adverse effects were reported.

Conclusions: RTX appears to be effective in RNS across various clinical and pathological subtypes, exhibiting a low relapse rate and minimal significant side effects in the majority of patients.

Keywords: Refractory nephrotic syndrome; complete remission; partial remission; rituximab; safety evaluation.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Chronic Disease
  • Glomerulonephritis, Membranous* / drug therapy
  • Glomerulosclerosis, Focal Segmental* / complications
  • Glomerulosclerosis, Focal Segmental* / drug therapy
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Nephrosis, Lipoid* / drug therapy
  • Nephrotic Syndrome* / drug therapy
  • Recurrence
  • Retrospective Studies
  • Rituximab / adverse effects
  • Treatment Outcome

Substances

  • Rituximab
  • Immunosuppressive Agents

Grants and funding

This study was supported by the Project of Pudong Health Bureau of Shanghai (PW2021D-04 and PWYgf2021-03 to Na Liu), the National Nature Science Foundation of China grants (82070791 to Na Liu, 82000645 to Lili Sheng), the Key Discipline Construction Project of Shanghai Pudong New Area Health Commission (PWZxk2022-05 to Na Liu), the Outstanding Leaders Training Program of Pudong Health Bureau of Shanghai (PWR12021-02 to Na Liu), the Shanghai Scientific Committee of China (23ZR1452200 and 20ZR1445800 to Na Liu), the Shanghai Health Bureau and Shanghai administration of traditional Chinese Medicine of China (ZHYY-ZXYJHZX-202114 to Na Liu), and the clinical investigation grant of Shanghai East Hospital (DFLC2022016 to Na Liu).