Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
Pediatr Nephrol. 2011 Oct;26(10):1823-8. doi: 10.1007/s00467-011-1886-x. Epub 2011 May 10.
Rituximab (RTX) has a significant steroid-sparing effect in children with steroid-dependent nephrotic syndrome (SDNS). However, patients are likely to relapse with the recovery of CD20+ cells. We conducted a small prospective cohort study with a historical control to evaluate the effect of RTX infusion followed by mycophenolate mofetil (MMF) as a maintenance therapy. Nine patients with SDNS who stopped their steroid treatment but were treated with MMF after RTX infusion were prospectively observed (group A). Seven patients with SDNS who discontinued steroid and immunosuppressive agents after RTX administration served as a control (group B). During the first year after the administration of RTX, six patients in group A and one patient in group B did not suffer a relapse (p < 0.05). The number of patients who relapsed during the 1 year preceding RTX treatment did not differ between the two groups [4.1 (A) vs. 5.7 (B)], but it was significantly lower in the MMF-treated group 1 year after the RTX treatment [0.4 (A) vs. 2.3 (B), p < 0.005]. The daily amount of prednisolone after the RTX treatment was lower in group A than in group B (0.11 vs. 0.46 mg/kg/day, respectively; p < 0.05). Three patients in group A and five patients in group B relapsed to SDNS and needed additional RTX treatment(s) within 1 year (odds ratio 5.0). Based on these results, we conclude that maintenance therapy with MMF after RTX is a good clinical option.
利妥昔单抗（RTX）在依赖激素的肾病综合征（SDNS）患儿中具有显著的激素节省作用。然而，随着 CD20+细胞的恢复，患者可能会复发。我们进行了一项小的前瞻性队列研究，并与历史对照进行比较，以评估 RTX 输注后使用吗替麦考酚酯（MMF）作为维持治疗的效果。9 名停止激素治疗但在 RTX 输注后接受 MMF 治疗的 SDNS 患者被前瞻性观察（A 组）。7 名在 RTX 给药后停止激素和免疫抑制剂治疗的 SDNS 患者作为对照（B 组）。在 RTX 给药后的第一年，A 组中有 6 名患者和 B 组中有 1 名患者没有复发（p<0.05）。两组患者在 RTX 治疗前 1 年内复发的患者人数没有差异[4.1（A）与 5.7（B）]，但在 RTX 治疗后 1 年内接受 MMF 治疗的患者复发率显著降低[0.4（A）与 2.3（B），p<0.005]。A 组患者在 RTX 治疗后每天接受的泼尼松剂量低于 B 组[分别为 0.11 与 0.46mg/kg/天；p<0.05]。A 组中有 3 名患者和 B 组中有 5 名患者复发至 SDNS，并在 1 年内需要额外的 RTX 治疗（比值比 5.0）。基于这些结果，我们得出结论，RTX 后使用 MMF 进行维持治疗是一种较好的临床选择。
