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Systematic Review and Meta-Analysis of Rituximab for Steroid-Dependent or Frequently Relapsing Nephrotic Syndrome in

Xia Gao1, Yan Wang2,3, Zichuan Xu1

  • 1Nephrology Department, Guangzhou Women and Children's Medical Center, Guangzhou, China.

Frontiers in Pediatrics
|August 9, 2021
PubMed

Insights

Rituximab (RTX) significantly reduces relapse rates and steroid dependence in children with nephrotic syndrome. This systematic review found RTX to be an effective and safe treatment option with fewer adverse events.

Area of Science:

  • Pediatric Nephrology
  • Immunology
  • Pharmacology

Background:

  • Steroid-dependent or frequently relapsing nephrotic syndrome (NS) in children poses significant treatment challenges.
  • Current therapies often involve long-term immunosuppression with potential side effects.

Approach:

  • A systematic review and meta-analysis of six randomized controlled trials (RCTs) were conducted.
  • Literature search across major biomedical databases (PubMed, Web of Science, Cochrane, EMBASE, CBM) up to November 1, 2019.
  • Cochrane bias risk assessment and RevMan 5.3 software were used for data analysis.

Key Points:

  • Rituximab (RTX) significantly decreased the relapse rate of nephrotic syndrome (NS) in children compared to controls (OR = 0.11, p = 0.001).
  • RTX treatment led to a significant reduction in the use of steroids and/or calcineurin inhibitors (OR = 0.05, p = 0.0007).
  • For steroid-dependent cases, RTX significantly lowered steroid dosage (SMD = -1.49, p < 0.00001) with no significant change in protein excretion (p = 0.08).

Conclusions:

  • Rituximab (RTX) is an effective therapy for pediatric steroid-dependent or frequently relapsing nephrotic syndrome.
  • RTX demonstrated a favorable safety profile with fewer reported serious adverse reactions.
  • The findings support RTX as a valuable therapeutic option in managing challenging cases of childhood nephrotic syndrome.

Keywords:
effect and safetymeta-analysisnephrotic syndromerituximabsystematic review

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