Li Xueting, Yan Peng, Zhang Lu, Qiao Wei, Xue Zhengbiao, Fang Xiangdong, Ke Ben, Zhu Shuying
Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Department of Healthy Center, Nanchang Normal University, Nanchang, Jiangxi, China.
Front Pharmacol. 2025 Jan 6;15:1403562. doi: 10.3389/fphar.2024.1403562. eCollection 2024.
Minimal change disease (MCD) is a podocytopathy more commonly seen in children, but it also accounts for 10%-25% of adult nephrotic syndrome. High-dose oral glucocorticoids were recommended for initial treatment of MCD. However, long-term use of systemic corticosteroids is associated with significant adverse events, such as steroid-induced diabetes and infections. The aim of this study was to investigate the clinical efficacy and safety of half-dose glucocorticoids combined with rituximab (RTX) for the initial treatment of MCD.
We recruited 74 patients with MCD confirmed by renal biopsy. Twenty patients were treated with RTX alone with 1000 mg at d1 and d15, 28 patients received half-dose prednisolone (0.5 mg/kg) per day combined with RTX with 1000 mg at d1, and 26 patients received high-dose prednisolone (1 mg/kg) per day. Treatment responses, including complete remission (CR) and partial remission (PR), and outcome adverse events such as steroid-induced diabetes and infections were compared among the three groups after 12 months of follow-up.
At the 12-month follow-up, the CR rates were 50%, 96.4%, and 96.2% for the RTX group, half-dose prednisolone combined with RTX group, and high-dose prednisolone group, respectively. There was no statistical difference between the half-dose prednisolone combined with RTX group and high-dose prednisolone group on CR and PR and kidney function ( > 0.05). Compared with the high-dose prednisolone group, the half-dose prednisolone combined with RTX group had a reduced incidence of adverse events of steroid diabetes ( = 0.041), especially in patients older than 55 years of age.
The efficiency of half-dose prednisolone combined with RTX is not inferior to the recommended treatment regimen, and this regimen can effectively reduce the incidence of steroid-induced diabetes in patients with MCD. Moreover, we recommend a half-dose prednisolone combined with RTX treatment for elderly patients with MCD.
微小病变病（MCD）是一种足细胞病，在儿童中更为常见，但它也占成人肾病综合征的10%-25%。高剂量口服糖皮质激素被推荐用于MCD的初始治疗。然而，长期使用全身性糖皮质激素会伴有显著的不良事件，如类固醇诱导的糖尿病和感染。本研究的目的是探讨半剂量糖皮质激素联合利妥昔单抗（RTX）用于MCD初始治疗的临床疗效和安全性。
我们招募了74例经肾活检确诊为MCD的患者。20例患者仅接受RTX治疗，分别在第1天和第15天给予1000mg；28例患者每天接受半剂量泼尼松龙（0.5mg/kg）联合RTX治疗，第1天给予1000mg；26例患者每天接受高剂量泼尼松龙（1mg/kg）治疗。随访12个月后，比较三组患者的治疗反应，包括完全缓解（CR）和部分缓解（PR），以及类固醇诱导的糖尿病和感染等不良事件结局。
在12个月的随访中，RTX组、半剂量泼尼松龙联合RTX组和高剂量泼尼松龙组的CR率分别为50%、96.4%和96.2%。半剂量泼尼松龙联合RTX组与高剂量泼尼松龙组在CR、PR和肾功能方面无统计学差异（P>0.05）。与高剂量泼尼松龙组相比，半剂量泼尼松龙联合RTX组类固醇糖尿病不良事件的发生率降低（P=0.041），尤其是在年龄大于55岁的患者中。
半剂量泼尼松龙联合RTX的疗效不低于推荐治疗方案，且该方案可有效降低MCD患者类固醇诱导的糖尿病的发生率。此外，我们推荐半剂量泼尼松龙联合RTX治疗老年MCD患者。
