Efficacy of low-dose rituximab in minimal change disease and prevention of relapse
Jian Zhang1, Hui Zhao1, Xiaoli Li1
1Division of nephrology, Gansu Provincial Hospital, Lanzhou, 730001, China.
Background:
Minimal change disease (MCD) is a major cause of nephrotic syndrome (NS) in children and a minority of adults. The higher tendency to relapse put patients at risk for prolonged exposure to steroids and other immunosuppressive agents. B cell depletion with rituximab (RTX) may be beneficial to the treatment and prevention of frequently relapsing MCD. Therefore, this study aimed to verify the therapeutic/preventive effects of low-dose RTX on the relapse in adult with MCD.
Methods:
A total of 33 adult patients were selected for the study, including 22 patients with relapsing MCD in relapse treatment group who were treated with low-dose RTX (200 mg per week × 4 following by 200 mg every 6 months) and 11 patients in relapse prevention group with complete remission (CR) after steroid therapy were treated with RTX (200 mg ×1 every 6 months) for preventing the relapse of MCD.
Results:
Of the 22 patients with MCD in relapse treatment group, there were 21 cases (95.45%) of remission [2 (9.09%) partial remission (PR), 19 (86.36%) CR], 1 (4.56%) no remission (NR) and 20 (90.90%) relapse-free. The Median duration of sustained remission was 16.3 months (3, 23.5 months, inter quartile range (IQR)). 11 patients in the relapse prevention group during a follow-up of 12 months (9-31 months) had no relapse. The average dose of prednisone in two groups after RTX treatment was significantly lower than before treatment.
Conclusion:
The results of this study suggested low-dose RTX can significantly reduce relapse rate and steroid dose in adults with MCD with fewer side effects. Low-dose RTX regimens may be beneficial for the treatment of relapsing MCD in adults and may be the preferred regimen for patients at high risk for the development of adverse events from corticosteroids.
Insights
Low-dose rituximab (RTX) effectively reduces relapses and steroid dependence in adult minimal change disease (MCD). This treatment offers a safer alternative for patients at risk of corticosteroid side effects.
Area of Science:
- Nephrology
- Immunology
Background:
- Minimal change disease (MCD) is a primary cause of nephrotic syndrome in children and some adults.
- Frequent relapses in MCD necessitate prolonged immunosuppression, increasing risks.
- Rituximab (RTX), a B cell depleting agent, shows potential in managing relapsing MCD.
Purpose of the Study:
- To evaluate the therapeutic and preventive effects of low-dose RTX on relapse rates in adult MCD patients.
- To assess the impact of low-dose RTX on steroid requirements and side effects.
Main Methods:
- A total of 33 adult MCD patients were studied.
- 22 patients with relapsing MCD received low-dose RTX for treatment (200 mg weekly x 4, then 200 mg every 6 months).
- 11 patients in remission received low-dose RTX for relapse prevention (200 mg every 6 months).
Main Results:
- 95.45% of treated patients achieved remission (86.36% complete remission).
- 90.90% of treated patients remained relapse-free.
- Patients in both groups showed a significant reduction in average prednisone dose post-RTX treatment.
- No relapses occurred in the 11 patients in the prevention group over a median follow-up of 12 months.
Conclusions:
- Low-dose RTX significantly reduces relapse rates in adult MCD.
- RTX therapy lowers the required steroid dose, mitigating associated side effects.
- Low-dose RTX is a beneficial and potentially preferred option for treating relapsing MCD in adults, especially those at high risk for corticosteroid adverse events.
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