Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Effects of Rituximab Including Long-term Maintenance Therapy in Children with Nephrotic Syndrome in a Single Center of Korea

  • Kim, Seong Heon (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Lim, Taek Jin (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Song, Ji Yeon (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Kim, Su Young (Department of Pediatrics, Pusan National University Children's Hospital)
  • Received : 2018.03.06
  • Accepted : 2018.03.27
  • Published : 2018.04.30
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Abstract

Rituximab (RTX) is a chimeric monoclonal antibody that inhibits CD20-mediated B-cell proliferation and differentiation. Several studies have examined its use in intractable nephrotic syndrome (NS) with some positive results. However, those studies examined such effects for a short-term period of 1 year, and some patients continued to relapse after a lapse in RTX treatment. Our use of RTX as a maintenance therapy (RTX injection when the CD19 cell count exceeded $100-200/{\mu}L$ before relapse) showed some noticeable efficacy. We used RTX in 19 patients with steroid-dependent NS (SDNS). In 12 patients treated with RTX maintenance therapy, only one relapse occurred. The mean treatment period was $23.4{\pm}12.7months$, and the mean number of RTX administrations was $3.9{\pm}1.6$. The relapse rates were decreased (from 2.68/year to 0.04/year), and the drug-free period also increased (from 22.5 days/year to 357.1 days/year) during maintenance therapy. The other seven patients were treated with one cycle of RTX or additional cycles in case of relapse (non-maintenance therapy). Relapse rates were significantly decreased after RTX treatment (from 1.76/year to 0.96/year, P=0.017). The relapse-free period was $15.55{\pm}7.38$ (range, 5.3-30.7) months. No severe side effects of RTX were found except for a hypersensitivity reaction such as fever and chills during its infusion. In conclusion, RTX is considered an effective and safe option to reduce the relapse rate by a single- or maintenance-interval therapy in SDNS.

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References

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