Lin Yuxin, Pan Yixuan, Han Quan, Xu Jianhang, Wang Junni, Lei Xin, Chen Liangliang, Wang Yaomin, Ren Pingping, Lan Lan, Chen Jianghua, Han Fei
Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Institute of Nephrology, Zhejiang University, Hangzhou, China.
Am J Nephrol. 2025;56(1):111-120. doi: 10.1159/000541972. Epub 2024 Oct 11.
Rituximab has proven effective and safe in pediatric and adult minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) patients with frequently relapsing nephrotic syndrome. However, its efficacy diminishes in several patients who experience nephrotic syndrome relapsing in short durations or failing to achieve remission. We aimed to explore the efficacy and safety of obinutuzumab, a novel anti-CD20 antibody, in these patients.
A retrospective case series study at our center included 11 adult MCD or FSGS patients who presented with nephrotic syndrome characterized by short-duration relapses or lack of remission after multitarget therapy, including rituximab. Primary outcomes included the first relapse-free time, relapse rate during follow-up, and the use of immunosuppressants after obinutuzumab. All adverse events were recorded.
Eleven adult patients (median age 26.0 years, 81.9% males) received an average obinutuzumab dose of 2.0 (1.0, 2.0) g during a median follow-up period of 17.0 (12.0, 22.0) months. The first relapse-free time was 12.1 (10.8, 18.9) months. Two patients with FSGS experienced relapses, while the remaining maintained remission by the end of follow-up. Six patients (54.5%) achieved cessation of corticosteroids and immunosuppressants within 3 months after obinutuzumab. Adverse events were mostly mild.
Obinutuzumab may be an efficient and safe option for inducing remission in adult MCD and FSGS patients who presented with nephrotic syndrome relapsing in short durations or failed to achieve remission after multitarget therapy, including rituximab. It was effective in maintaining remission in MCD patients, while its efficacy in maintaining remission in FSGS patients remained uncertain.
利妥昔单抗已被证明在患有频繁复发肾病综合征的儿童和成人微小病变病（MCD）及局灶节段性肾小球硬化（FSGS）患者中有效且安全。然而，在一些肾病综合征短期内复发或未实现缓解的患者中，其疗效会降低。我们旨在探讨新型抗CD20抗体奥滨尤妥珠单抗在这些患者中的疗效和安全性。
我们中心的一项回顾性病例系列研究纳入了11例成年MCD或FSGS患者，这些患者表现为肾病综合征，其特征为短期复发或在包括利妥昔单抗在内的多靶点治疗后未缓解。主要结局包括首次无复发时间、随访期间的复发率以及奥滨尤妥珠单抗治疗后免疫抑制剂的使用情况。记录所有不良事件。
11例成年患者（中位年龄26.0岁，81.9%为男性）在中位随访期17.0（12.0，22.0）个月期间平均接受了2.0（1.0，2.0）g奥滨尤妥珠单抗治疗。首次无复发时间为12.1（10.8，18.9）个月。2例FSGS患者复发，其余患者在随访结束时维持缓解状态。6例患者（54.5%）在奥滨尤妥珠单抗治疗后3个月内停用了糖皮质激素和免疫抑制剂。不良事件大多为轻度。
对于患有短期内复发或在包括利妥昔单抗在内的多靶点治疗后未缓解的肾病综合征的成年MCD和FSGS患者，奥滨尤妥珠单抗可能是诱导缓解的一种有效且安全的选择。它在维持MCD患者缓解方面有效，而其在维持FSGS患者缓解方面的疗效仍不确定。
