ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

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

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Gupta, Krishan Lal L., Postgraduate Institute of Medical Education & Research, Chandigarh, India
  • Duseja, Ritambhra Nada, Postgraduate Institute of Medical Education & Research, Chandigarh, India
  • Ramachandran, Raja, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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.