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Rituximab/Mycophenolate Combination Therapy in Children with Calcineurin Inhibitor-Resistant FSGS

Saumil Gaur1, Partha P Paul2, Mounika Motamarri2

  • 1Consultant Paediatrician and Transplant Nephrologist, Rainbow Children Hospital, Marathahalli, Bangalore, Karnataka, India.

Indian Journal of Nephrology
|April 22, 2024
PubMed

Insights

Dual therapy with rituximab and mycophenolate offers a promising treatment for children with calcineurin inhibitor-resistant focal segmental glomerulosclerosis (FSGS). This approach successfully maintained remission in most patients, showing efficacy in a challenging pediatric kidney disease.

Area of Science:

  • Pediatric Nephrology
  • Immunosuppressive Therapy
  • Glomerular Diseases

Background:

  • Focal segmental glomerulosclerosis (FSGS) in children presents limited therapeutic options, particularly CNI-resistant forms.
  • Calcineurin inhibitors (CNIs) like tacrolimus and cyclosporine are standard but not universally effective.
  • Novel strategies are needed for pediatric FSGS unresponsive to CNI treatment.

Purpose of the Study:

  • To evaluate the efficacy of a dual therapy regimen in children with CNI-resistant FSGS.
  • To assess the ability of rituximab and mycophenolate combination therapy to maintain remission.
  • To analyze treatment outcomes and safety in this specific pediatric population.

Main Methods:

  • Retrospective analysis of 13 children with CNI-resistant FSGS.
  • Treatment involved dual therapy with rituximab and mycophenolate for at least 1 year.
  • Outcomes measured included sustained remission, renal function, and adverse events.

Main Results:

  • 84.6% of children achieved sustained remission at 1 year post-dual therapy.
  • The therapy was effective in both steroid-dependent and steroid-resistant FSGS cases.
  • No adverse reactions or infections were reported, with preserved renal function.

Conclusions:

  • Dual rituximab and mycophenolate therapy is a promising and effective strategy for CNI-resistant pediatric FSGS.
  • This combination can achieve sustained remission in a significant majority of treated children.
  • The treatment demonstrates a favorable safety profile with preserved kidney function.
Abstract

Keywords:
Calcineurin inhibitor resistanceFSGSmycophenolaterituximab

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