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Long-term outcomes after early treatment with rituximab for Japanese children with cyclosporine- and steroid-resistant nephrotic syndrome

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Abstract

Background

Although rituximab (RTX) may be effective treatment in children with nephrotic syndrome who are resistant to cyclosporine A and steroid (CsA-SRNS), long-term outcomes after B cell depleting therapy remain unclear.

Case-diagnosis/treatment

We retrospectively reviewed the clinical courses (median follow-up, 5.1 years) of six CsA-SRNS children (three boys; median age at RTX, 4.2 years) unresponsive to oral cyclosporine combined with ≥ 2 courses of intravenous methylprednisolone pulses, who received RTX within 6 months after disease onset (median 11 weeks). After initial RTX treatment (median two doses of 375 mg/m2) followed by retreatment with intravenous methylprednisolone pulses and/or high-dose prednisolone, all patients achieved complete remission at a median of 158 days. Although 17 relapses occurred in five patients during follow-up, all but one patient became steroid sensitive. Severe neutropenia and hypogammaglobulinemia developed in two and four patients, respectively. However, no life-threatening infections were identified in the cohort. At last visit (median age, 11.3 years), all patients maintained complete remission without renal insufficiency.

Conclusions

Although late-onset adverse events should be considered, particularly for young patients, early RTX treatment may have positive outcomes in children with CsA-SRNS in the long term.

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Funding

SF has received clinical research funding B at Saitama Children’s Medical Center.

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Authors and Affiliations

  1. Division of Nephrology, Saitama Children’s Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama city, Saitama, 330-8777, Japan

    Shuichiro Fujinaga, Tomohiko Nishino, Chisato Umeda, Yuji Tomii, Yoshitaka Watanabe & Koji Sakuraya

Authors
  1. Shuichiro Fujinaga
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  2. Tomohiko Nishino
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  3. Chisato Umeda
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  4. Yuji Tomii
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  5. Yoshitaka Watanabe
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  6. Koji Sakuraya
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Corresponding author

Correspondence to Shuichiro Fujinaga.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and/or national research committee at which the study was conducted with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

All patients and their parents provided written informed consent. The use of RTX in patients with refractory SR/SDNS in this study was approved by the ethics committee of the aforementioned center (approved number at Saitama Children’s Medical Center, 2007-03-001).

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Fujinaga, S., Nishino, T., Umeda, C. et al. Long-term outcomes after early treatment with rituximab for Japanese children with cyclosporine- and steroid-resistant nephrotic syndrome. Pediatr Nephrol 34, 353–357 (2019). https://doi.org/10.1007/s00467-018-4145-6

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  • DOI: https://doi.org/10.1007/s00467-018-4145-6

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