Renal Division, Department of Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany.
Nephron Clin Pract. 2012;120(2):c79-85. doi: 10.1159/000335142. Epub 2012 Jan 26.
BACKGROUND/AIMS: Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are common causes of nephrotic syndrome (NS) in adults. However, induction of remission and sustained control of proteinuria is often difficult. Recently, B cell-directed therapy using the anti-CD20 antibody rituximab has been suggested as induction regimen in pediatric FSGS and MCD patients. Data on rituximab use in adults are still limited.
We report on rituximab use in five consecutively treated adult patients (mean age 42.2 ± 9.9 years) with FSGS or relapsing MCD (2 FSGS, 3 MCD) who failed to respond to standard immunosuppressive treatment. Median follow-up was 8 months (3-25).
Rituximab induced complete remission in 2 MCD patients and partial remission in 3 patients. Proteinuria was reduced by 86.8% (42.9-95.2) 3 months and by 73.0% (60.1-95.5) 6 months after therapy. In 1 patient with severe FSGS, partial remission was not evident before 6 months after rituximab treatment. Relapses occurred in 2 patients. No severe adverse events related to rituximab were observed.
Our findings suggest that B cell-directed therapies are novel treatment options for adults with refractory NS. Response to rituximab varied, with MCD patients exhibiting a faster and more pronounced response compared to FSGS patients.
背景/目的：微小病变性肾病（MCD）和局灶节段性肾小球硬化症（FSGS）是成人肾病综合征（NS）的常见病因。然而，诱导缓解和持续控制蛋白尿往往较为困难。最近，使用抗 CD20 抗体利妥昔单抗的 B 细胞靶向治疗被建议用于儿科 FSGS 和 MCD 患者的诱导方案。关于利妥昔单抗在成人中的应用数据仍然有限。
我们报告了连续治疗的 5 例成人 FSGS 或复发性 MCD 患者（平均年龄 42.2±9.9 岁，2 例 FSGS，3 例 MCD）的利妥昔单抗使用情况，这些患者对标准免疫抑制治疗无反应。中位随访时间为 8 个月（3-25）。
利妥昔单抗诱导 2 例 MCD 患者完全缓解，3 例患者部分缓解。蛋白尿在治疗后 3 个月时减少了 86.8%（42.9-95.2），在 6 个月时减少了 73.0%（60.1-95.5）。在 1 例严重 FSGS 患者中，在利妥昔单抗治疗后 6 个月之前未出现部分缓解。2 例患者复发。未观察到与利妥昔单抗相关的严重不良事件。
我们的研究结果表明，B 细胞靶向治疗是难治性 NS 成人的一种新的治疗选择。对利妥昔单抗的反应存在差异，MCD 患者的反应更快、更明显，而 FSGS 患者则较慢。
