HDCN Abstract:  ASN Annual Meeting -- San Diego  

Sellier-Leclerc A, Baudouin V, Macher M, et al.

Rituximab in Steroid Sensitive Nephrotic Syndrome.

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

Most children with nephrotic syndrome respond to steroids, but a significant number develop steroid dependency. Although many immunosuppressive agents were proved effective, some severe cases remain difficult to treat and need multidrug therapy.

Twenty nine children suffering from steroid sensitive nephrotic syndrome were treated with rituximab (RTX) for steroid dependency. The duration of the disease before RTX ranged from 0.7 to 17.5 years (mean 10.3). All patients had been treated with cyclosporine (N = 21) or tacrolimus (n = 8) for 0.5 to 15.8 years (mean 8.3).

Following the first cure of RTX, all patients had undetectable B cell count. The duration of complete B depletion following this first cure ranged from 3.0 to 15.3 months with a mean of 7.8 months.

During the first 15th months of depletion, a first group of 10 patients experienced a relapse of nephrotic syndrome: 8 simultaneously to the recurrence of circulating B cells and 1 while the B cell count was below 5/mm3. B-cells depletion was easly obtained with additional reinjections of RTX in 7 patients. A second group of 19 patients had sustained remission: 18 with complete B cell depletion, either after the first cure of RTX (n=4) or after additional re- injections (n=14) and 1 had sustained remission 13.7 months after the recurrence of circulating B cells.
At last follow-up, 15 patients were depleted for more than 15 months. One experienced a relapse simultaneously to the recurrence of circulating B cells and 14 had sustained remission either with complete B cell depletion (n = 7) or after the recurrence of circulating B cells (n=7; mean duration of 5.8 months; range 0.4-10.2). Prednisone therapy have been stopped in 23/29 patients, mycophenolate in 20/25, cyclosporine or tacrolimus in 21/24.

In conclusion, RTX and B cell depletion allow to sustain remission in steroid sensitive nephrotic syndrome despite the decrease and the withdrawal of immunosuppressive and steroid therapy. Long lasting B cell depletion leads to protracted remission in patients with steroid and multidrug dependency, even after the withdrawal of RTX and the subsequent normalization of B cell count in the blood.

© 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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