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Rituximab in childhood steroid-sensitive nephrotic syndrome: are multiple subsequent courses safe and effective?
  1. Chantida Subun1,2,
  2. Picha Suwannahitatorn3,
  3. Hazel Webb1,
  4. Kjell Tullus1
  1. 1 Nephrology, Great Ormond Street Hospital for Children, London, UK
  2. 2 Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
  3. 3 Phramongkutklao College of Medicine, Bangkok, Thailand
  1. Correspondence to Dr Kjell Tullus, Nephrology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; Kjell.Tullus{at}


Introduction Idiopathic nephrotic syndrome is the most common glomerular disease in children. The majority of patients respond well to steroids. However, the relapse rate is high and many develop steroid dependency. Although other immunosuppressive medicines are successfully used as steroid-sparing agents, some children still have frequent relapsing episodes. Rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, has shown to be effective in treating difficult frequently relapsing/steroid-dependent nephrotic syndrome (FR/SDNS). Data on the effectiveness and long-term treatment outcomes of repeated courses of RTX are, however, scarce.

Material and methods Children and young people with FR/SDNS, aged 1–18 years, who received RTX at Great Ormond Street Hospital (GOSH) from 2006 to 2018 were reviewed.

Results During these 12 years, 103 children with FR/SDNS received RTX infusions at GOSH. Among these, 58 cases needed repeated courses of RTX: 2, 3, 4, 5, 6 and 7 repeated courses were given to 21, 21, 7, 5, 1 and 3 patients, respectively. The overall median time to relapse post-RTX was 11 months (range 1–53 months). There was no change in relapse-free interval with subsequent courses of RTX. No difference was found between age groups, genders and ethnicities. No severe side effects were noted.

Conclusions RTX seems to be safe even after several repeated courses. However, long-term follow-up and further studies are needed, with a focus on side-effects in particular.

  • nephrology
  • therapeutics
  • syndrome

Data availability statement

No data are available. This was an internal audit of the service. No data available for public use.

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Data availability statement

No data are available. This was an internal audit of the service. No data available for public use.

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  • Contributors KT conceived of the idea. CS and HW collected data. CS, PS and KT carried out data analysis and interpretation. CS drafted the manuscript. KT carried out critical revision and approved the final version of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.