Erschienen in:
01.03.2010 | Brief Report
Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine
verfasst von:
Shuichiro Fujinaga, Daishi Hirano, Naoto Nishizaki, Koichi Kamei, Shuichi Ito, Yoshiyuki Ohtomo, Toshiaki Shimizu, Kazunari Kaneko
Erschienen in:
Pediatric Nephrology
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Ausgabe 3/2010
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Abstract
Rituximab (RTX) has been successfully used as a rescue therapy in children with steroid-dependent nephrotic syndrome (SDNS). However, little is known regarding maintenance therapy after a successful response to RTX in such patients. The efficacy and safety of a single RTX infusion (375 mg/m2) were assessed in ten patients who had persistent SDNS associated with minimal-change disease (MCD) despite the long-term use of cyclosporine (CsA). The mean follow-up after RTX infusion was 17 months. Applying RTX resulted in a significant reduction in the mean prednisolone (PSL) dose from 0.39 ±0.18 to 0.15 ± 0.14 mg/kg per day. The mean 12-month relapse rates significantly decreased from 4.1 ± 1.7 to 0.6 ± 0.6. All but one patient who had continued CsA as maintenance therapy after a single RTX infusion were able to withdraw from PSL without any relapses during the study period, whereas the remaining five patients who discontinued CsA experienced relapses after CD19 cells re-emerged, leading to the reintroduction of CsA or an additional RTX infusion. Infusion reactions occurred in five of ten patients. These data indicate that a single RTX infusion may improve response to CsA in patients with persistent SDNS due to the phenomenon of secondary resistance to CsA.