Abstract: TH-PO156

Repeat Rituximab Dosing Is Often Necessary but Effective in Relapsing Minimal Change Disease in Adults

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Wong, Nikki L., Imperial College London, London, United Kingdom
  • Cairns, Tom, IMPERIAL COLLEGE HEALTHCARE, LONDON, United Kingdom
  • Galliford, Jack W., Imperial College Kidney and Transplant Institute, London, United Kingdom
  • Pusey, Charles D., Imperial College London, London, United Kingdom
  • Griffith, Megan, Imperial College London, London, United Kingdom
Background

Rituximab (RTX) is increasingly being used for relapsing minimal change disease (MCD) in adults, but data is lacking on the need for and efficacy of multiple dosing regimens.

Methods

We retrospectively reviewed 19 patients treated with RTX for relapsing, or steroid resistant MCD between 2006-2017. Median age at treatment was 35 years (20-66), mean time from diagnosis 15 years (1-39), and mean relapse rate was 4/last 3 years. Previous maintenance treatment included steroids (17/19), tacrolimus (19/19), ciclosporin (6/19), mycophenolate (1/19), cyclophosphamide/chlorambucil (8/19) and levamisole (3/19).

Results

19 patients received RTX. 8 patients were nephrotic, and 11 were in complete or partial remission at time of treatment. B-cell depletion was achieved in all patients. 10 patients had more than one RTX course [mean 2 (1-4)], the mean follow-up was 34 months (1-127).

Of 8 patients who were nephrotic at RTX initiation, 6 achieved complete or partial remission and 2 failed to respond. 1/2 was steroid resistant and on subsequent rebiopsy was found to have FSGS, the other was steroid intolerant.

Of 17 patients in remission post RTX, 9 had no further relapse at mean follow-up of 17 months (1-60). 3/9 received a second course of RTX after a mean 13 months (9-16). At last follow-up 5/9 have reconstituted B-cells (>10) at a mean of 6 months post RTX (1-11), while 4/9 remain B-cell deplete.

8/17 patients relapsed post RTX, at a mean 13 months (5-35). All relapsed patients had B-cell reconstitution at time of relapse. 7/8 who relapsed had a second course of RTX. 6 of these 7 relapsed again at a mean of 22 months (7-53) post redosing, 5 of these 6 patients received a third course of RTX. All 5 are now in remission and relapse free at a mean 7 months (1-14). 1 patient received a prophylactic fourth RTX course at B-cell reconstitution.

There were no serious infusion reactions; and one case of Pneumocystis infection requiring hospitalization.

Conclusion

RTX is effective for relapsing MCD in adults, but repeated treatment courses may be required. B-cell reconstitution is associated with relapse and may be helpful in guiding prophylactic redosing in some patients. Nonresponse to RTX may suggest underlying FSGS. Further trials are needed to determine which patients will relapse and appropriate dosing regimens for maintenance RTX therapy.