Kamei Koichi, Okada Mari, Miyazono Akinori, Sato Mai, Fujimaru Takuya, Ogura Masao, Ito Shuichi
Department of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Nihon Jinzo Gakkai Shi. 2013;55(5):947-55.
Rituximab, an anti-CD2O monoclonal antibody, is an emerging and effective option for the treatment of patients with refractory steroid-dependent nephrotic syndrome (SDNS), but few studies have assessed the long-term prognosis in these patients. We therefore evaluated the efficacy of rituximab in 35 patients, aged 4-21 years, who experienced SDNS while being treated with immunosuppressants. Patients were monitored for 24-63 months. After the first infusion of rituximab, the number of relapses and the dose of prednisolone were significantly reduced, and the steroid withdrawal period was significantly increased. However, 22 patients (63%) required retreatment with rituximab owing to relapses. At the last observation, only three patients (9%) could discontinue immunosuppressants completely and only three continued to show remission during the observation period. Although rituximab could not induce a complete cure of refractory SDNS, it resulted in longer remission times when immunosuppressants were continued after rituximab therapy, indicating the effectiveness of rituximab followed by immunosuppressants. We also found that patients who experienced more relapses before rituximab therapy were more likely to relapse earlier after rituximab therapy.
利妥昔单抗是一种抗CD20单克隆抗体，是治疗难治性激素依赖型肾病综合征（SDNS）患者的一种新兴且有效的选择，但很少有研究评估这些患者的长期预后。因此，我们评估了利妥昔单抗对35例年龄在4至21岁、在接受免疫抑制剂治疗时发生SDNS的患者的疗效。对患者进行了24至63个月的监测。首次输注利妥昔单抗后，复发次数和泼尼松龙剂量显著减少，激素撤减期显著延长。然而，22例患者（63%）因复发需要再次接受利妥昔单抗治疗。在最后一次观察时，只有3例患者（9%）能够完全停用免疫抑制剂，只有3例在观察期内持续缓解。虽然利妥昔单抗不能诱导难治性SDNS完全治愈，但在利妥昔单抗治疗后继续使用免疫抑制剂时，可延长缓解时间，表明利妥昔单抗联合免疫抑制剂有效。我们还发现，在利妥昔单抗治疗前复发次数较多的患者，在利妥昔单抗治疗后更早复发的可能性更大。
