Rituximab Benefits Adults with Steroid-Dependent Nephrotic Syndrome

Rituximab is a safe and effective treatment for adult patients with steroid-dependent minimal change disease, reports a study in Kidney International.

The study included 17 adults receiving the anti-CD20 monoclonal antibody rituximab for steroid-dependent (15 patients) or frequently relapsing (two patients) minimal change nephrotic syndrome. Patients were treated at two French nephrology departments between 2002 and 2011. Rituximab therapy was started after the patients failed to respond to immunosuppressive darugs. Mean follow-up was 29.5 months.

Eleven patients had no further relapses a mean of 26.7 months after rituximab infusion. Of these, nine patients were able to stop steroids and other immunosuppressive medications during follow-up. The remaining six patients had at least one relapse after a mean of 11.9 months. However, all were able to stop or substantially reduce their use of immunosuppressive drugs during this time (mean follow-up 34.5 months). There were no adverse events associated with rituximab therapy.

Patients with steroid-dependent nephrotic syndrome may need long-term treatment with multiple drugs, placing them at risk for drug toxicity and renal failure. Studies in children with steroid-dependent nephrotic syndrome have shown that rituximab can reduce steroid dosage and immunosuppressive drug requirements.

This French experience finds that anti-CD20 therapy with rituximab is “efficient and safe” for adult patients with severe steroid-dependent minimal change disease. Randomized trials are needed to confirm the results and to assess the value of preventive rituximab reinfusion after the reappearance of CD19 cells—which often precedes relapse [Munyentwali H, et al:Rituximab is an efficient and safe treatment in adults with steroid-dependent minimal change disease. Kidney Int 2013; 83: 511–516].

April 2013 (Vol. 5, Number 4)