HDCN Abstract:  ASN Annual Meeting -- San Diego  

Adalat S, Taylor J, Reid C, et al.

Efficacy of Rituximab in Steroid Dependent and Steroid Resistant Nephrotic Syndrome in Children and Young Adults.

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:416A 2009

Objectives. To explore the efficacy of rituximab in childhood steroid dependent and steroid resistant nephrotic syndrome and its relationship with CD20 B lymphocyte depletion.

Background. Rituximab, a CD20 specific B lymphocyte depleting antibody may induce remission of minimal change disease (MCND) and focal segmental glomerulosclerosis (FSGS). We tested the hypothesis that this indicated a pathogenic role for B lymphocytes by studying 20 cases of idiopathic NS in children and young adults pre- and post rituximab for 36 months. Further immunological investigations were performed to acquire clues as to the mechanism of action.

Methods. 20 cases, 4 female and 16 male were treated with rituximab. 10 were steroid resistant and 10 steroid dependent. Histological diagnoses were MCND 9; FSGS 10, C1q nephropathy 1. The number of courses of rituximab/patient was 1-4. Median duration of therapy prior to rituximab was 9 months (range 1-156 months). Cases were examined for clinical response and immunological alterations.

Results. 16/20 cases responded to the first course of rituximab in 2 to 4 weeks. 3 non-responders had advanced disease, 1 did not deplete B cells. No significant adverse side effects were noted. Nephrotic remission was directly correlated with CD20 B cell depletion and relapse with CD20 recovery. 90% of cases required re-treatment after 6 9 months. Re-emergence of steroid and/or calcineurin inhibitor sensitivity was observed. No reduction in efficacy of rituximab occurred on repeat dosing or alteration in measured clinical immunological parameters were detected.

Conclusions. Rituximab is safe and efficacious in childhood NS. Our data indicates an integral role for B lymphocytes in this disease, but that the response is likely to be more complex than simply depletion of peripheral B lymphocyte subsets.

© Copyright 2009-2010 American Society of Nephrology.Reproduced with permission.
Until September of 2010 all ASN abstracts from the 2009 Annual Meeting are available at this link.

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