Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China.
Biomedical and Health Informatics, University of Washington, Seattle, WA, USA.
Drug Des Devel Ther. 2021 May 10;15:1945-1953. doi: 10.2147/DDDT.S302257. eCollection 2021.
There is currently a lack of studies investigating long-term prognosis and the necessity of further rituximab (RTX) consolidation treatment for minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). The aim of this study was to evaluate the efficacy of RTX for these diseases and to investigate whether a consolidation treatment can lower risks of relapse and reinforce long-term remission.
A retrospective study was conducted. The relapse and remission of 70 patients treated with 1 course of RTX treatment (4 infusions of 375 mg/m2) over a median follow-up time of 27 months (12-60 months) were analyzed. The rates of patients that were able to achieve non-relapse for a duration of 24 months between RTX consolidation therapy and non-consolidation therapy were compared.
There were 67 cases (95.71%) of remission and 3 cases (4.29%) of non-remission. The average number of relapses decreased from 3.7±2.5 times before the treatment to 0.8±1.8 times after treatment (P <0.001). The average avannual number of relapses decreased from 1.3±1.2 times/year to 0.2±0.3 times/year (P <0.001). The results from the Cox proportional-hazards model showed that the risk of relapse in patients who received RTX non-consolidation treatment was significantly higher than those with consolidation treatment (odds ratios (OR) 20.9, 95% confidence intervals (CI) OR 5.7-75.7, p<0.001). The 24-month relapse-free rate was also significantly higher in patients with consolidation therapy compared with non-consolidation therapy (86.36% vs 25%, p<0.001). No adverse events were recorded.
RTX is highly effective in treating MCD and FSGS, and RTX consolidation therapy may be recommended to reinforce long-term remissions.
目前缺乏研究调查微小病变病（MCD）和局灶节段性肾小球硬化症（FSGS）的长期预后和是否需要进一步用利妥昔单抗（RTX）巩固治疗。本研究旨在评估 RTX 治疗这些疾病的疗效，并探讨巩固治疗是否可以降低复发风险并增强长期缓解。
进行了一项回顾性研究。分析了中位随访时间为 27 个月（12-60 个月）的 70 例患者接受 1 个疗程 RTX 治疗（4 次，每次 375mg/m2）的复发和缓解情况。比较了 RTX 巩固治疗与非巩固治疗之间，患者在 24 个月内达到非复发的比例。
有 67 例（95.71%）患者缓解，3 例（4.29%）患者未缓解。治疗前平均复发次数从 3.7±2.5 次减少到治疗后 0.8±1.8 次（P<0.001）。平均年复发次数从 1.3±1.2 次/年减少到 0.2±0.3 次/年（P<0.001）。Cox 比例风险模型的结果显示，接受 RTX 非巩固治疗的患者复发风险明显高于接受巩固治疗的患者（比值比（OR）20.9，95%置信区间（CI）OR 5.7-75.7，p<0.001）。与非巩固治疗相比，巩固治疗患者 24 个月无复发率也明显更高（86.36% vs 25%，p<0.001）。未记录到不良反应。
RTX 治疗 MCD 和 FSGS 非常有效，RTX 巩固治疗可能有助于增强长期缓解。
