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30.09.2020 | Original Article

Prophylactic rituximab administration in children with complicated nephrotic syndrome

verfasst von: Mika Okutsu, Koichi Kamei, Mai Sato, Toru Kanamori, Kentaro Nishi, Sho Ishiwa, Masao Ogura, Mayumi Sako, Shuichi Ito, Kenji Ishikura

Erschienen in: Pediatric Nephrology | Ausgabe 3/2021

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Abstract

Background

Rituximab is effective for maintaining remission in patients with complicated nephrotic syndrome, although a history of steroid-resistant nephrotic syndrome (SRNS) is a risk factor for early relapse. We investigated the efficacy of prophylactic rituximab treatment for maintaining remission after B cell recovery.

Methods

Patients with complicated steroid-dependent or frequently relapsing nephrotic syndrome with history of SRNS who received a single dose of rituximab (375 mg/m²) and continued immunosuppressive agents were enrolled in this retrospective study. Patients were divided into two groups: a prophylaxis group, which received additional rituximab treatment at B cell recovery and a non-prophylaxis group. The relapse-free period from the last rituximab infusion (the second treatment in prophylaxis group and the first treatment in non-prophylaxis group) was compared between two groups using the Kaplan-Meier method, and risk factors for early relapse were calculated using multivariate analysis by Cox proportional hazards model.

Results

Sixteen patients in the prophylaxis group and 45 in the non-prophylaxis group were enrolled. Fifty-percent relapse-free survival after the last rituximab treatment was 667 days in the former and 335 days in the latter (p = 0.001). Multivariate analysis showed that additional rituximab treatment was the only significant negative factor for early relapse, with a hazard ratio of 0.40 (p = 0.02). Fifty-percent relapse-free survival after B cell recovery was much longer in the prophylaxis group (954 vs. 205.5 days, p = 0.003).

Conclusions

Additional rituximab treatment at B cell recovery can maintain prolonged remission even after B cell recovery in patients with complicated nephrotic syndrome with history of SRNS.

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Titel: Prophylactic rituximab administration in children with complicated nephrotic syndrome
verfasst von: Mika Okutsu
Koichi Kamei
Mai Sato
Toru Kanamori
Kentaro Nishi
Sho Ishiwa
Masao Ogura
Mayumi Sako
Shuichi Ito
Kenji Ishikura
Publikationsdatum: 30.09.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 3/2021
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-020-04771-5

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Prophylactic rituximab administration in children with complicated nephrotic syndrome