Kidney Week

Abstract: FR-OR083

CD-19 Targeted Rituximab Is Safe and Effective in Adult Steroid Dependent/Resistant but Calcineurin Inhibitor Dependent Podocytopathy

Session Information

• Glomerular Diseases: Clinical, Outcomes, and Trials
  October 26, 2018 | Location: 24A, San Diego Convention Center
  Abstract Time: 05:30 PM - 05:42 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Gupta, Krishan Lal L., Postgraduate Institute of Medical Education & Research, Chandigarh, India

Krishan Lal L. Gupta, MD, FASN

• Duseja, Ritambhra Nada, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Ritambhra Nada Duseja,

• Ramachandran, Raja, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Raja Ramachandran,

Background

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are common podocytopathies causing nephrotic syndrome (NS) in children and adults. A significant proportion of patients are either steroid dependent (SD) or resistant (SR), requiring alternate therapies. Long-term calcineurin inhibitors (CNI) use is associated with dyslipidemia, impaired glucose tolerance and, nephrotoxicity. Rituximab is a potential candidate in this group of patients, with a more favourable safety profile, so the present study was undertaken to evaluate the efficacy and safety of rituximab in SD/SR MCD/FSGS dependent on CNIs to maintain remission.

Methods

This was a prospective observational study conducted from July 2014 to February 2018. SD-NS or SR-NS (biopsy proven MCD/FSGS), who were CNI dependent were enrolled. All patients received rituximab at a dose of 375 mg/m² at entry in the study. CD-19 levels were monitored monthly and patients having CD-19 levels >5/µL and/or >1% received additional low-dose (100 mg) of rituximab. Patients were followed up monthly for a period of 12 months, and the clinical and biochemical parameters prior to and following rituximab administration were compared. Outcome: Cumulative percentage of patients who experienced remission (Complete remission (CR), partial remission (PR)) at 6 and 12 months.

Results

A total of 24 patients was enrolled and followed for 12 months. Mean age at enrolment was 22.77±7.45 years. At the end of 6 and 12 months, 87.50% and 79.16% of the patients achieved remission, respectively. CR and PR at 6 and 12 months were observed in 14 (58.33%) and 7 (29.17%), and 13 (54.16%) and 6 (25%), patients, respectively. Relapse occurred in 7 (29.16%) patients during the follow-up, requiring steroids (4, 57.14%) or CNIs (3, 42.85%). The mean dose of rituximab was 791 mg. Rituximab was well-tolerated, with infusion reactions, respiratory tract infection and oral candidiasis in 5 (20.83%), 5 (20.83%) and 1 (4.17%) patient, respectively.

Conclusion

CD-19 targeted rituximab is a safe and effective agent in the management of adults with CNI dependent MCD/FSGS. At 12 months, over three-fourth of the patients with CNI dependent podocytopathy maintain clinical remission.