Abstract: TH-PO157

Rituximab Treatment of Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) in Adults

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Regunathan-Shenk, Renu, Columbia University College of Physicians and Surgeons, New York, New York, United States
  • Bomback, Andrew S., Columbia University College of Physicians and Surgeons, New York, New York, United States
  • Canetta, Pietro A., Columbia University College of Physicians and Surgeons, New York, New York, United States
  • Ahn, Wooin, Columbia University College of Physicians and Surgeons, New York, New York, United States
  • Appel, Gerald B., Columbia University College of Physicians and Surgeons, New York, New York, United States
Background

Previous retrospective and prospective studies have suggested that rituximab may be an effective therapy for patients (Pts) with MCD and FSGS who have failed other therapies. Most studies have had small numbers of Pts and consisted largely of children.

Methods

We reviewed the charts of 58 adults (41 male) evaluated at Columbia University Medical Center between 2014 - 2017 who received rituximab for MCD or FSGS. We analyzed clinical, biopsy, and laboratory data pre-infusion and at follow up (F/U). We categorized Pts as frequently relapsing/steroid dependent (FRSD), infrequently relapsing (IR), steroid resistant (SR), and multi-drug resistant (MDR) based on their clinical course prior to rituximab.

Results

On renal biopsy, 31 Pts had MCD, 22 had FSGS, and 5 had podocytopathy associated with another diagnosis (e.g. IgA Nephropathy with MCD). There were 34 Whites, 13 Latinos, 6 Blacks, and 5 Asians. Disease category included 33 FRSD, 2 IR, 6 SR, and 17 MDR. Three patients (all FRSD) were excluded from further analysis; 2 Pts had <1 month (mo) of F/U and 1 was unable to complete treatment due to infusion reaction. The median number of immunosuppressant (IS) medications used prior to rituximab was 3 (range 1-6). The median number of concurrent IS was 1 (range 0-3) at time of infusion and 0 (range 0-2) at F/U. The median F/U was 15.8 mo (range 1.4-159). 62% (37/55) achieved a complete remission (CR, UPC <0.5 g/gCr) or partial remission (PR, UPC 0.5-3.5 g/gCr) during the F/U period; 32 remained in CR or PR and 5 relapsed by last F/U. Of patients in remission at last F/U, 13/22 Pts in CR and 5/10 Pts in PR were off all other IS. Of 23 Pts not in remission at last F/U, 12 never achieved CR or PR, 5 had relapsed, and 6 had progressed to ESRD. Of 17 MDR Pts, 3 achieved CR or PR after rituximab, 3 achieved CR or PR on other IS, and 11 never achieved CR or PR, with 3 progressing to ESRD. 18 Pts repeated rituximab treatment, 9 prophylactically, and 9 for treatment of relapse with all responding.

Conclusion

This is the largest study showing the benefit of rituximab in achieving remission of proteinuria and reduction of immunosuppression in adults with MCD or FSGS. Pts with MDR disease were less likely to respond to rituximab.