Sun Mingfang, Wang Ling, Liu Xinghong, Xiao Fei, Dai Huanzi
Department of Rheumatology & Clinical Immunology, Daping Hospital & Research Institute of Surgery, Army Medical University, Chongqing, PR China.
Department of Nephrology, Daping Hospital & Research Institute of Surgery, Army Medical University, Chongqing, PR China.
Clin Kidney J. 2024 Jun 27;17(8):sfae178. doi: 10.1093/ckj/sfae178. eCollection 2024 Aug.
Immunoglobulin A nephropathy (IgAN) with podocytopathy is a rare pathological type of glomerular disease. The use of rituximab (RTX) in the treatment of glomerular diseases has increased in recent decades, but the efficacy of RTX in the treatment of patients with IgAN and podocytopathy has rarely been reported.
This was a single-centre retrospective study of IgAN patients with podocytopathy who were treated with RTX as second-line therapy was conducted at our centre from 2019 to 2022. The aim of this study was to investigate the efficacy and safety of RTX in IgAN patients with podocytopathy.
Seven out of eight patients met the criteria for complete remission following RTX therapy. Only one patient experienced adverse events (infectious diarrhoea and pulmonary infection) and experienced relapse 6 months after RTX therapy. The maximum relapse-free time after RTX therapy was 20 months, while the maximum relapse-free time before RTX therapy was only 6 months. The number of relapses before RTX therapy (per year) was one to four; moreover, seven patients did not relapse and maintained remission at the last follow-up despite steroid withdrawal after RTX therapy.
Overall, RTX effectively reduced proteinuria, increased the maximum relapse-free time, reduced the number of relapses per year and helped patients stop steroid use as soon as possible. RTX also helped most patients achieve clinical remission. RTX appears to be an effective and safe alternative for treating IgAN patients with podocytopathy with steroid dependence or frequent relapse.
伴足细胞病的免疫球蛋白A肾病（IgAN）是一种罕见的肾小球疾病病理类型。近几十年来，利妥昔单抗（RTX）在肾小球疾病治疗中的应用有所增加，但RTX治疗IgAN伴足细胞病患者的疗效鲜有报道。
这是一项单中心回顾性研究，于2019年至2022年在我们中心对接受RTX作为二线治疗的IgAN伴足细胞病患者进行。本研究的目的是调查RTX治疗IgAN伴足细胞病患者的疗效和安全性。
8例患者中有7例在RTX治疗后达到完全缓解标准。仅1例患者出现不良事件（感染性腹泻和肺部感染），并在RTX治疗后6个月复发。RTX治疗后的最长无复发时间为20个月，而RTX治疗前的最长无复发时间仅为6个月。RTX治疗前每年的复发次数为1至4次；此外，7例患者在RTX治疗后停用类固醇，在最后一次随访时未复发并维持缓解。
总体而言，RTX有效降低蛋白尿，延长最长无复发时间，减少每年复发次数，并帮助患者尽快停用类固醇。RTX还帮助大多数患者实现临床缓解。对于治疗依赖类固醇或频繁复发的IgAN伴足细胞病患者，RTX似乎是一种有效且安全的替代治疗方法。
