Long-term Rituximab Therapy in Adult Patients with Idiopathic Nephrotic Syndrome

Area of Science:

• Nephrology
• Immunology
• Pharmacology

Background:

• Refractory idiopathic nephrotic syndrome (INS) poses risks including infections, renal failure, and immunosuppressive side effects.
• Long-term management strategies for INS are crucial for patient outcomes.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of yearly rituximab therapy in adult patients with refractory INS.
• To assess treatment outcomes in minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), and membranous glomerulopathy (MG) subgroups.

Main Methods:

• Prospective investigation of adult INS patients receiving yearly rituximab over 5-10 years.
• Subgroup analysis based on diagnosis: MCD, FSGS, and MG.
• Monitoring for remission, response to therapy, need for continued treatment, and adverse events, including in pregnant patients.

Main Results:

• In MCD, 14/15 patients achieved complete remission (CR), with 8/14 not needing further rituximab after 4 years.
• In FSGS, rituximab ameliorated INS in 9/11 patients, though 2 developed end-stage renal disease (ESRD).
• In MG, 36/38 patients achieved CR, with 55% not requiring further treatment after 4 years; 2/38 developed ESRD. Nine pregnant women received rituximab without fetal adverse effects.

Conclusions:

• Yearly rituximab is a safe, practical, and effective long-term therapy for adult patients with refractory INS across MCD, FSGS, and MG.
• A significant proportion of patients achieving remission may not require continuous treatment.
• Rituximab demonstrated a favorable safety profile, even in pregnant patients.