Abstract: TH-PO170

Intermittent Dosing of Rituximab Induces Long-Term Remission in Children with Steroid Dependent Nephrotic Syndrome

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Sanchez, Cheryl P., Loma Linda University Children's Hospital, Loma Linda, California, United States
  • Sheth, Rita D., Loma Linda University Children's Hospital, Loma Linda, California, United States
  • Cutler, Drew C., Loma Linda University Children's Hospital, Loma Linda, California, United States
  • Sahney, Shobha, Loma Linda University Children's Hospital, Loma Linda, California, United States
Background

Rituximab is frequently used as an alternative therapy in pediatric patients with nephrotic syndrome.

Methods

17 children, 10.7 ± 3.4 years old, received rituximab infusion at 375 mg/m2 per dose weekly x 4 weeks. Renal biopsy showed minimal change, n=10; IgM nephropathy, n=2; FSGS, n=3; C1Q, n=1; no biopsy n=1. All patients were taking prednisone and prograf at the time of rituximab infusion. Prior to rituximab, five out of 17 patients had ≥ 5 relapses per year, 4/17 ≥ 4 relapses per year, 3/17 ≥ 3 relapses per year, 5/17 without remission.

Results

After 4 weekly doses of rituximab, 12 patients (70%) had complete remission, 2/17 had partial remission and 3/17 did not respond to rituximab. Five of 12 relapsed within 6-12 months of receiving rituximab, 4/10 relapsed 12 months after rituximab, 3/13 remained in remission. CD20 levels decreased at 3 months after rituximab compared to baseline (10 ± 8% vs 0.03 ± 0.07%, p<0.05), and started to increase at 6 months, 2.3 ± 3.8%. There was no correlation noted between CD20 levels and proteinuria. Nine out of 12 patients who relapsed received 1.7 ± 0.8 additional doses of rituximab at 12 ± 3.2 months after last relapse, and remained in remission for an additional 6.4 ± 3.4 months. Five out of 9 children were off prednisone and prograf, and 4/9 remained on low dose prograf. One patient who had partial remission developed anaphylaxis to rituximab, but successfully treated with ofatumumab. There were no complications associated with repeated rituximab therapy.

Conclusion

Intermittent doses of rituximab can be used to maintain remission in steroid dependent nephrotic syndrome to avoid long term complications associated with prolonged prednisone and calcineurin therapy.