Feder Omri, Amsterdam Dana, Ershed Mohamad, Grupper Ayelet, Schwartz Doron, Kliuk-Ben Bassat Orit
Department of Internal Medicine H, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.
BMC Nephrol. 2025 Mar 6;26(1):126. doi: 10.1186/s12882-025-04035-0.
Corticosteroids are highly efficient for treatment of minimal change disease (MCD), however a substantial number of patients become steroid dependent (SD) or frequent relapsing (FR). Response rate is lower in primary Focal Segmental Glomerulosclerosis (FSGS). Since prolonged exposure to corticosteroids should be avoided, an effective alternative is required. Rituximab is a promising agent. We aimed to evaluate the efficacy of Rituximab in adults with SD/FR nephrotic syndrome (NS).
A retrospective cohort study, evaluating patients with SD/FR NS treated with Rituximab in a tertiary hospital. Rituximab was given at induction, with additional doses subjected to the treating nephrologist decision. Primary outcome was number of relapses and time to first relapse. Safety was assessed.
Twenty-one adults were included. Among them, 14 (66.7%) were diagnosed with MCD, 5 (23.8%) with FSGS, in 2 cases kidney biopsies were not performed. Median age was 54.6 years. Median follow up was 39.6 months. Number of relapses decreased significantly after Rituximab compared to before treatment (median relapses 0 compared to 3, respectively, W = 3.70, p <.001). Time to first relapse was significantly shorter before Rituximab compared to after (median 11 vs. 536 days, respectively, W = 3.05, p =.002). Hazzard Ratio for relapse was higher in patients who received one Rituximab course compared to those who received an additional maintenance (HR = 4.31, 95% CI: 1.13-16.39, p =.032). Treatment was well-tolerated, serious adverse events included cholecystitis and severe COVID-19.
Rituximab emerges as an efficient safe steroid sparing in patients with SD/FR NS, with longer remission achieved when an additional maintenance dose is given after the first course.
皮质类固醇对微小病变病（MCD）的治疗非常有效，然而，相当一部分患者会出现类固醇依赖（SD）或频繁复发（FR）。原发性局灶节段性肾小球硬化（FSGS）的缓解率较低。由于应避免长期接触皮质类固醇，因此需要一种有效的替代药物。利妥昔单抗是一种有前景的药物。我们旨在评估利妥昔单抗在患有SD/FR肾病综合征（NS）的成人中的疗效。
一项回顾性队列研究，评估在一家三级医院接受利妥昔单抗治疗的SD/FR NS患者。诱导期给予利妥昔单抗，额外剂量由治疗肾病专家决定。主要结局是复发次数和首次复发时间。评估安全性。
纳入21名成人。其中，14例（66.7%）诊断为MCD，5例（23.8%）诊断为FSGS，2例未进行肾活检。中位年龄为54.6岁。中位随访时间为39.6个月。与治疗前相比，利妥昔单抗治疗后复发次数显著减少（中位复发次数分别为0次和3次，W = 3.70，p <.001）。与治疗后相比，利妥昔单抗治疗前首次复发时间显著缩短（分别为中位11天和536天，W = 3.05，p =.002）。接受一个疗程利妥昔单抗治疗的患者复发的风险比高于接受额外维持治疗的患者（HR = 4.31，95% CI：1.13 - 16.39，p =.03）。治疗耐受性良好，严重不良事件包括胆囊炎和重症COVID-19。
利妥昔单抗是一种有效且安全的类固醇替代药物，适用于SD/FR NS患者，在第一个疗程后给予额外的维持剂量可实现更长时间的缓解。
