Abstract: TH-PO994
Rituximab as a Rescue Treatment of Primary Podocytopathies in a Brazilian University Center
Session Information
- Glomerular Diseases: Minimal Change Disease, FSGS, IgAN
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Sales, Gabriel Teixeira Montezuma, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Fernandes, Danilo Euclides, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Rocha, Daniel Ribeiro da, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Mastroianni-kirsztajn, Gianna, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
Background
Focal and segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) are two primary glomerulopathies which usually present with nephrotic syndrome and classified together as podocitopathies. The first one is common in adults and the second one in children. The currently available treatments for both diseases have important side effects. High rates of steroid and cyclosporine resistance and dependence are indicative that new therapeutic options are mandatory. The main objective of our study is to describe the profile of patients with podocytopathy who used rituximab in a brazilina university center.
Methods
This is a retrospective cohort including 18-year-old or older patients with kidney biopsy showing MCD or FSGS who have used at least 1 dose of rituximab between 2012 and 2018, with a minimum of 6 months of follow up after infusion. Epidemiological, clinical and histological variables were analyzed. Were considered responders patients with at least a 35% reduction in proterinuria and an increment of 0.5 g/dL of serum albumin.
Results
Twenty-eight patients fulfilled the inclusion criteria, 57% female, median creatinine and age at the time of the infusion was 1.1 mg/dL and 33 years-old, respectively. The main indications were lack of response to traditional immunosuppressors and frequent relapse during or after corticosteroid withdrawal, with previous use of cyclosporine in 76% and prednisone in 96%. Median 24-h urinary protein at infusion were 8.40 g (5.30 - 12.64, IQR) in non-responders and 7.65 g (1.34 - 17.63, IQR). After 3 months they resulted 7.06 g (5.62 - 9.97, IQR) and 0.25 g (10 - 5.51, IQR), respectively. The complete remission rate in 3 was 24% and in 6 months was 10%. Partial remission was present after 3 months in 33% of the cases. Evaluating non steroid resistant patients, 58% of them had partial remission at 3 months while no steroid resistant individual had any type of remission. In relation to side effects, 18% had an infection episode up to 6 months after infusion and 2 patients presented rash, with no severe drug reaction.
Conclusion
Rituximab is a possible option to use in FSGS and MCD especially in individuals considered steroid-sensitive and dependent and with an acceptable safety profile.