Introduction:
Rituximab has emerged as a promising therapeutic option for patients with frequently relapsing or steroid-dependent nephrotic syndrome (FR/SDNS). Both Minimal Change disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) pose significant clinical challenges due to their potential for frequent relapses and dependency on corticosteroids, leading to substantial morbidity and a diminished quality of life. Rituximab has shown to reduce relapse and corticosteroid dependency.
In this study, we aimed to comprehensively evaluate the efficacy and safety profile of rituximab in adult patients with FR/SDNS/resistent MCD and FSGS. Through this analysis, we seek to contribute valuable insights into optimizing treatment strategies for these challenging nephrotic syndrome subtypes.
Methods:
A retrospective cohort study included Sixty four FR/SDNS (MCD/FSGS)/ SRNS patients. Relapse rate, duration of relapse, requirement of additional dosage, Adverse events were well recorded.
Results:
In Our Study We included total Sixty four patients (45 MCD and 19 FSGS) who were given Rituximab.
· Mean age of diagnosis in MCD patients was 11.8± 12.1 years and rituximab was required after 6.3 ± 5.8 years after the diagnosis. For FSGS Mean age of diagnosis was 26.1± 16.7 years and required rituximab after 4.3 ± 1.07 years.
· Mean time to achieve remission after 1st dose of rituximab in MCD was 44.3 ± 14.16 days and in FSGS 117 ± 42.2 days.
· Remission was seen in 38 (84.4 %) patients in MCD at last follow up, 2 patients were in relapse and 2 were in partial remission, 3 patients lost to follow up; For FSGS 15 (78.9%) achieved remission. Relapse was seen in 1 (5.2%) patient, 3(15.7%) patients were in partial remission, 1 (5.2%)patient did not respond to treatment and 2 (10.5%) patients lost to follow up.
· Mean dose of rituximab required to achieve remission was 1250 mg.
· Relapse was noted after 152.8±27.3 days in MCD patients after 1st dose of rituximab and in FSGS 266.8±108.05 days.
· All patients were treated with steroids prior to rituximab, 9 (20%) MCD and 3 (15.7%) FSGS patients were treated with cyclophosphamide, Patients treated with cyclosporine: 6 (13%) MCD and 4 (21.6%) FSGS, Mycophenolate Mofetil: 8 (17.8) MCD and 4 (8.9%) FSGS, Tacrolimus: 12 (26.7%) MCD and 9 (47.4%) FSGS,
· 7 (10.9%) Patients were treated with multiple agents other than steroids prior to rituximab.
· 11 (24.4%) MCD patients were treated with Levamisol and out of which 3 patients later found out to be missed FSGS, confirmed by renal biopsy.
· 40 (88.9%) patients achieved steroid free treatment after rituximab in MCD group and 13 (68%) patients achieved steroid free treatment in FSGS group after Rituximab.
MCD FSGS
· Out of 5 steroid resistant cases 3 responded and achieved remission.
· 5 patients from MCD group and 2 patients with FSGS had allergic reaction to rituximab during infusion.
· 10 MCD patients and 3 FSGS patients had SAE (Out of which 11 had infective etiology) requiring hospitalization post rituximab treatment.
· None of the above patients reached ESRD. 2 patients with FSGS had AKI episodes.
Conclusions:
Our findings affirm that rituximab is an effective and safe therapeutic option for patients with frequently relapsing or steroid-dependent(FR/SD) and some resistant minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS). Rituximab not only sustains disease remission but also significantly reduces corticosteroid exposure, thereby mitigating the long-term side effects associated with prolonged steroid use.
I have no potential conflict of interest to disclose.
I used generative AI and AI-assisted technologies in the writing process.
During preparation I Used ChatGPT version 3.0 for grammar and word-sentence formation, I have reviewed and edited content as needed and i take full responsibility for the content of the publication.