Rituximab treatment for refractory nephrotic syndrome in adults: a multicenter retrospective study

Abstract

Background

The treatment of refractory nephrotic syndrome (RNS) is full of challenges and the role of rituximab (RTX) is not well-established, thus this study aims to demonstrate the role of RTX in RNS.

Methods

This was a multicenter retrospective study of all adult patients receiving RTX for RNS. Patients enrolled were divided into two groups according to pathological pattern: 20 patients as a group of podocytopathy (including minimal change disease [MCD] and focal and segmental glomerulosclerosis [FSGS]), and 26 patients as membranous nephropathy (MN) group. The remission rate, relapse rate, adverse effects, and predictors of remission were analyzed.

Results

A total of 75 patients received RTX for RNS and 48 were available for analysis after exclusion criteria. No significant difference in the remission rate at 6 or 12 months was observed between the MCD/FSGS and MN cases (p > 0.05). The median duration of the first complete remission (CR) was 1 month in the podocytopathy group and 12.5 months in the MN group. Three relapses were associated with infection as the ultimate outcome, and 6 out of 48 remained refractory representing a response rate of 87.5% in RNS. Clinical predictors of cumulative CR were estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² and mean arterial pressure (MAP) ≤103 mmHg at the beginning of therapy in patients with MN. No serious adverse effects were reported.

Conclusions

RTX appears to be effective in RNS across various clinical and pathological subtypes, exhibiting a low relapse rate and minimal significant side effects in the majority of patients.

Keywords:

• Refractory nephrotic syndrome
• rituximab
• complete remission
• partial remission
• safety evaluation

Author contributions

Na Liu: research idea and study design. Xiaoyan Ma, Lu Fang, Lili Sheng, Xun Zhou, Shoujun Bai, Xiujuan Zang, Yakun Wang, Mengke Li, Zexin Lv, Qin Zhong, Xinyu Yang, Yishu Wang, Yan Hu, Danying Yan, Yingfeng Shi, Hui Chen, Jinqing Li, Min Tao, and Yi Wang: data acquisition. Xiaoyan Ma, Lu Fang, Lili Sheng, Xun Zhou, Yi Wang, Shougang Zhuang, and Na Liu: statistical analysis and manuscript drafting or revision. Na Liu: supervision or mentorship. All authors: read and approved the final manuscript.

Ethics statement

This study was conducted according to the guidelines of the Helsinki Declaration and written informed consent was obtained from all patients. The study protocol was approved by the Human Research Ethics Committee of Shanghai East Hospital Affiliated with Tongji University School of Medicine (ChiCTR2200055680).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Project of Pudong Health Bureau of Shanghai (PW2021D-04 and PWYgf2021-03 to Na Liu), the National Nature Science Foundation of China grants (82070791 to Na Liu, 82000645 to Lili Sheng), the Key Discipline Construction Project of Shanghai Pudong New Area Health Commission (PWZxk2022-05 to Na Liu), the Outstanding Leaders Training Program of Pudong Health Bureau of Shanghai (PWR12021-02 to Na Liu), the Shanghai Scientific Committee of China (23ZR1452200 and 20ZR1445800 to Na Liu), the Shanghai Health Bureau and Shanghai administration of traditional Chinese Medicine of China (ZHYY-ZXYJHZX-202114 to Na Liu), and the clinical investigation grant of Shanghai East Hospital (DFLC2022016 to Na Liu).