Rituximab treatment combined with methylprednisolone pulse therapy and immunosuppressants for childhood steroid-resistant nephrotic syndrome

Koichi Kamei, Mari Okada, Mai Sato, Takuya Fujimaru, Masao Ogura, Makiko Nakayama, Hiroshi Kaito, Kazumoto Iijima, Shuichi Ito

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    Abstract

    Background: Calcineurin inhibitors (CIs) with/without intravenous methylprednisolone pulse therapy (MPT) constitute the standard treatment for childhood-onset, steroid-resistant nephrotic syndrome (SRNS). However, some patients fail to achieve remission. We treated SRNS patients resistant to CIs and MPT with additional rituximab combined with MPT and immunosuppressive agents. Methods: Ten patients (aged 2-14 years) with CI- and MPT-resistant SRNS were enrolled. Patients were administered rituximab (1-4 doses; 375 mg/m 2) followed by MPT (30 mg/kg/day of methylprednisolone for 3 consecutive days) once every 2-4 weeks until complete remission (CR). We analyzed clinical outcome and safety. Results: Six patients received a single dose of rituximab, 2 received two doses, and 2 received four doses. Seven patients achieved CR, 1 achieved partial remission, and 2 showed no response. Although 2 patients with no response progressed to end-stage renal failure, 7 patients with CR preserved normal renal function without proteinuria at the last observation. There were two serious adverse events. Conclusions: Additional rituximab combined with conventional MPT and immunosuppressive agents is a promising option for overcoming refractory SRNS. Aggressive B cell suppression by rituximab may ameliorate resistance to conventional treatments and a cocktail of other immunosuppressive agents, such as CIs,MMF, mizoribine, may be beneficial. However, as intense immunosuppression may cause serious adverse events, further evaluation is necessary.

    Original languageEnglish
    Pages (from-to)1181-1187
    Number of pages7
    JournalPediatric Nephrology
    Volume29
    Issue number7
    DOIs
    Publication statusPublished - 2014 Jul

    Keywords

    • B cell
    • Immunosuppressive agents
    • Methylprednisolone pulse therapy
    • Rituximab
    • Steroid-resistantnephrotic syndrome

    ASJC Scopus subject areas

    • Pediatrics, Perinatology, and Child Health
    • Nephrology

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    Kamei, K., Okada, M., Sato, M., Fujimaru, T., Ogura, M., Nakayama, M., Kaito, H., Iijima, K., & Ito, S. (2014). Rituximab treatment combined with methylprednisolone pulse therapy and immunosuppressants for childhood steroid-resistant nephrotic syndrome. Pediatric Nephrology, 29(7), 1181-1187. https://doi.org/10.1007/s00467-014-2765-z