Huang Jing, Pan Yan, Zhang Yi-Miao, Wang Xin, Meng Li-Qiang, Cheng Xu-Yang, Liu Gang, Zhao Ming-Hui, Cui Zhao
Renal Division, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; Key Laboratory of Chronic Kidney Disease (CKD) Prevention and Treatment, Ministry of Education of China, Beijing, China.
Renal Division, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; Key Laboratory of Chronic Kidney Disease (CKD) Prevention and Treatment, Ministry of Education of China, Beijing, China; Department of Nephrology, The First Affiliated Hospital of Bengbu Medical University, Bengbu City, Anhui Province, China.
Int Immunopharmacol. 2025 Jun 17;158:114795. doi: 10.1016/j.intimp.2025.114795. Epub 2025 May 10.
Steroid-dependent (SD) and frequently relapsing (FR) nephrotic syndrome, primarily due to minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS), poses significant treatment challenges. This study evaluates the efficacy and safety of rituximab in these patient populations.
We conducted a retrospective study of 94 patients with SD or FR nephrotic syndrome treated with rituximab. Clinical outcomes, including remission rates and relapse frequency, were assessed alongside B lymphocyte counts and anti-nephrin antibody detection.
Among the cohort, 88.3 % had MCD and 11.7 % had FSGS. Each patient received a median of 3 (IQR: 2, 4) infusions with a median total dose of 1700 (IQR: 1000, 2500) mg rituximab. All patients achieved clinical remission, with 87.2 % attaining complete remission. The median time to remission was 1.5 months. Relapse rates decreased significantly to 30.9 %, from a median of 4 relapses to 0 after treatment (P < 0.001). The median relapse-free duration extended to 50 months. Anti-nephrin antibodies were detected in 76.2 % of tested patients, suggesting a potential biomarker for SD/FR nephrotic syndrome. Rituximab was well tolerated, with mild adverse events observed.
Rituximab is an effective and safe therapeutic option for patients with SD or FR nephrotic syndrome due to MCD or FSGS. Further studies are warranted to optimize treatment protocols and investigate the role of biomarkers in predicting treatment response.
类固醇依赖型（SD）和频繁复发型（FR）肾病综合征主要由微小病变病（MCD）和局灶节段性肾小球硬化（FSGS）引起，带来了重大的治疗挑战。本研究评估了利妥昔单抗在这些患者群体中的疗效和安全性。
我们对94例接受利妥昔单抗治疗的SD或FR肾病综合征患者进行了一项回顾性研究。评估了包括缓解率和复发频率在内的临床结局，同时检测了B淋巴细胞计数和抗肾足细胞抗体。
在该队列中，88.3%患有MCD，11.7%患有FSGS。每位患者接受的利妥昔单抗输注中位数为3次（四分位间距：2，4），总剂量中位数为1700mg（四分位间距：1000，2500）。所有患者均实现临床缓解，其中87.2%达到完全缓解。缓解的中位时间为1.5个月。复发率从治疗前的中位数4次显著降至30.9%，治疗后降至0次（P<0.001）。无复发持续时间的中位数延长至50个月。在76.2%的检测患者中检测到抗肾足细胞抗体，提示其可能是SD/FR肾病综合征的生物标志物。利妥昔单抗耐受性良好，观察到轻度不良事件。
对于由MCD或FSGS引起的SD或FR肾病综合征患者，利妥昔单抗是一种有效且安全的治疗选择。有必要进一步研究以优化治疗方案并调查生物标志物在预测治疗反应中的作用。
