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2014 ; 93
(29
): e300
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Long-term prognosis of adult patients with steroid-dependent minimal change
nephrotic syndrome following rituximab treatment
#MMPMID25546674
Iwabuchi Y
; Takei T
; Moriyama T
; Itabashi M
; Nitta K
Medicine (Baltimore)
2014[Dec]; 93
(29
): e300
PMID25546674
show ga
This study was to evaluate the long-term efficacy and safety of a single-dose
rituximab regimen rituximab treatment in adult patients with steroid-dependent
minimal change nephrotic syndrome (MCNS). We conducted a prospective cohort study
with historical controls to evaluate the effect of single-dose infusions of
rituximab at 375 mg/m2 BSA per dose administered at intervals of 6 months for a
period of 24 months. At the end of the 24-month period, the patients were divided
into the treatment continuation (n = 20) and treatment discontinuation (n = 5)
groups according to their intention to continue/discontinue the treatment. A
significant reduction in the total number of relapses was observed during the
24-month period after the first rituximab infusion as compared with that during
the 24-month period before the first rituximab infusion (108 vs. 8, P < 0.001).
Complete remission was induced/maintained in all patients from 12 to 24 months
after the first rituximab infusion. In regard to the clinical course after 24
months, 4 of the 20 patients in the treatment continuation group discontinued the
rituximab treatment after the fifth infusion and 2 patients discontinued the
treatment after the sixth infusion. However, complete remission was maintained in
all the 20 patients of this group during the 12-month observation period after
the first four single-dose rituximab infusions. On the other hand, 1 of the 5
patients in the treatment discontinuation group developed relapse during the
observation period after the first four rituximab infusions, and the rituximab
treatment was resumed. In our trial, rituximab therapy was associated with
maintenance of complete remission. Complete remission was maintained even in most
of the patients who showed B-cell repletion after discontinuation of rituximab
therapy. Thus, rituximab may be considered as a radical therapeutic agent for
patients with steroid-dependent MCNS.