Abstract: TH-PO173
Effects of Rituximab in Adult Patients with Minimal Change Disease
Session Information
- Clinical Glomerular Disorders: FSGS, MN, MCD
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1005 Clinical Glomerular Disorders
Authors
- Roccatello, Dario, Ospedale San GIovanni Bosco, Torino, Italy
- Sciascia, Savino, Ospedale San GIovanni Bosco, Torino, Italy
- Fenoglio, Roberta, Ospedale San GIovanni Bosco, Torino, Italy
Background
Minimal change disease (MCD) accounts for 15-20 % of adult nephrotic syndrome cases; adult-MCD patients (pts) may have more severe clinical features than pediatric pts. Therefore, active therapy and remission are very relevant for these patients. In children, rituximab (RTX) has been used since 2006 to treat frequently relapsing NS. In adults, data about the efficacy of RTX for MCD is limited. It is still not clear whether RTX is best used to induce remission or to maintain it, what the optimal dose should be and whether repeated doses improve response rates and prolong remission. We report a monocentric experience on the use of RTX in adult biopsy-proven MCD
Methods
Our series includes 5 adult pts (2 males and 3 females), aged 27-73 yrs treated with RTX (4 weekly doses of RTX 375 mg/m2 or 1 gr two weeks apart). RTX was administrated as a rescue therapy in 2 pts (1 pt with previous long term corticosteroid therapy; 1 pt received corticosteroids and immunosuppressive drugs in infancy). 3 pts with major risk factors precluding corticosteroids or conventional immunosuppression received RTX as a first-line treatment.
Results
Proteinuria decreased from 8.4 (19.5-4.8) g/24 h to 0.03 g/24 h after 6 months; creatinine decreased from 1.44 (0.7-3.2) mg/dl to 0.86 (0.7-1.1) mg/l. 3 pts achieved a complete renal remission, in 1 pt proteinuria decreased by 50%. 1 pt didn’t achieved any response at 10 months; a ri-biopsy showed a focal-segmental-glomerulosclerosis. RTX successfully depleted CD19 lymphocytes in 100% of pts for at least 6 months. The follow-up ranged from 3 months to 24 months. No clinically relevant adverse events have been observed.
Conclusion
Our study shows a remarkable efficacy of RTX in treatment of MCD. RTX can be an attractive alternative as induction therapy or to manage recurrent forms of MCD. RTX may be preferentially used in pts at a high risk of development of the adverse effects of corticosteroids and should be considered as an important treatment alternative in patients with recurrent nephrotic syndrome. Randomized controleld trials are needed to confirmed our observations.