Effect of single-dose rituximab on steroid-dependent minimal-change nephrotic syndrome in adults

被引:60
作者
Takei, Takashi [1 ]
Itabashi, Mitsuyo [1 ]
Moriyama, Takahito [1 ]
Kojima, Chiari [1 ]
Shiohira, Syunji [1 ]
Shimizu, Ari [1 ]
Tsuruta, Yuki [1 ]
Ochi, Ayami [1 ]
Amemiya, Nobuyuki [1 ]
Mochizuki, Toshio [1 ]
Uchida, Keiko [1 ]
Tsuchiya, Ken [1 ]
Nitta, Kosaku [1 ]
机构
[1] Tokyo Womens Med Univ, Dept Med, Kidney Ctr, Tokyo, Japan
关键词
nephrotic syndrome; relapse; rituximab; steroid dependent minimal-change; CYCLOSPORINE; REMISSION; CHILDREN; THERAPY; RELAPSE;
D O I
10.1093/ndt/gfs515
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Steroid-dependent minimal-change nephrotic syndrome (MCNS) requires administration of prolonged courses of prednisolone (PSL); therefore, a paradigm shift from such toxic non-specific therapies to selective immunomodulating regimens is necessary for these cases. To assess the therapeutic effects of rituximab (an anti-CD20 antibody) in adult patients with steroid-dependent MCNS, we performed a prospective trial of the effects of a single dose of rituximab administered twice at an interval of 6 months in 25 MCNS patients. We evaluated the biochemical parameters and compared the clinical findings between the 12-month period before and 12-month period after the first rituximab infusion. A significant reduction in the number of relapses and the total dose and the maintenance dose of PSL administered was observed during the 12-month period after the first rituximab infusion when compared with the findings during the 12-month period before the first rituximab infusion [25 (100) versus 4 (16), P 0.001; 8.2 versus 3.3 g, P 0.001; 26.4 mg/day at baseline versus 1.1 mg/day at 12-month, P 0.0001]. Complete remission was achieved/maintained in all patients undergoing B-cell depletion. Four of 17 patients with B-cell repletion developed relapse. Our results revealed that rituximab therapy was associated with a reduction in the number of relapses and in the total dose of PSL needed. Therefore, rituximab appears to be a useful therapeutic agent for adult patients with steroid-dependent MCNS. These results suggest that this treatment is rational and should be considered as an important option in the management of adult patients with steroid-dependent MCNS.
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收藏
页码:1225 / 1232
页数:8
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