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Therapeutic efficacy of rituximab for the management of adult-onset steroid-dependent nephrotic syndrome: a retrospective study

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Abstract

Background

Recent reports have described the efficacy of rituximab in treating steroid-dependent nephrotic syndrome (SDNS) in pediatric patients. However, few reports describe data regarding adult-onset SDNS. We investigated the efficacy of rituximab for the management of adult-onset SDNS.

Methods

We performed a retrospective cohort study investigating eight patients with adult-onset SDNS who were treated with rituximab. Clinical data were obtained at the initiation of rituximab therapy. The primary outcomes evaluated were successful suppression of relapses and CD19+ cells after rituximab treatment. The corticosteroid- and immunosuppressant-sparing effect and adverse events were additionally evaluated.

Results

All eight patients were diagnosed with minimal change nephrotic syndrome and received immunosuppressants in addition to corticosteroid. Total number of relapses was 10.5 times as a median value. Rituximab administration was repeated in two patients, whereas six received single-dose rituximab. Three of eight (37.5%) patients showed relapse after rituximab therapy. A rituximab-induced depletion in CD19+ cells noted initially was followed by their reappearance in all patients. There were cases with no relapse after the reappearance of CD19+ cells. The median relapse time pre- and post-rituximab therapy showed a decrease from 1 time/year (interquartile range [IQR] 1–3 times/year) to 0 time/year (IQR 0–1 time/year). Rituximab treatment induced a significant reduction in the required doses of corticosteroid and cyclosporine (P < 0.01). No serious adverse events were observed.

Conclusion

Rituximab treatment was effective not only in childhood-onset but also in adult-onset SDNS. Further studies are needed to establish optimal treatment regimens.

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Acknowledgements

This study was supported partly by a Grant-in-Aid for Progressive Renal Diseases Research, and Research on Rare and Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.

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Authors and Affiliations

  1. Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan

    Takayuki Katsuno & Yasuhiko Ito

  2. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Takayuki Katsuno, Tomohiro Masuda, Shoji Saito, Noritoshi Kato, Takuji Ishimoto, Sawako Kato, Tomoki Kosugi, Naotake Tsuboi & Shoichi Maruyama

  3. Department of Pathology, National Hospital Organization Chiba East Hospital, Chiba, Japan

    Hiroshi Kitamura

  4. Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan

    Toyonori Tsuzuki

Authors
  1. Takayuki Katsuno
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  2. Tomohiro Masuda
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  3. Shoji Saito
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  4. Noritoshi Kato
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  11. Yasuhiko Ito
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  12. Shoichi Maruyama
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Corresponding author

Correspondence to Takayuki Katsuno.

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Conflict of interest

The Department of Nephrology and Rheumatology, Aichi Medical University received research promotion grants from Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Co., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Limited., and Torii Pharmaceutical Co., Ltd. The Department of Nephrology, Nagoya University Graduate School of Medicine received research promotion grants from Astellas Pharma Inc., Bristol-Myers Squibb., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical Co., Ltd., MSD K.K., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Limited., Torii Pharmaceutical Co., Ltd., and Sumitomo Dainippon Pharma Co., Ltd.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of The Ethics Committee for Human Research of Nagoya University Hospital at which the studies were conducted (IRB approval number 2017-0192) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The Ethical Committee approved this retrospective cohort study without written informed consent from patients; however, informed consent was obtained from most patients at the time of performing a renal biopsy.

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Katsuno, T., Masuda, T., Saito, S. et al. Therapeutic efficacy of rituximab for the management of adult-onset steroid-dependent nephrotic syndrome: a retrospective study. Clin Exp Nephrol 23, 207–214 (2019). https://doi.org/10.1007/s10157-018-1630-y

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  • DOI: https://doi.org/10.1007/s10157-018-1630-y

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