Abstract: TH-PO995
Rituximab Treatment of Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) in Adults
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
- Jeyabalan, Anushya, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Regunathan-Shenk, Renu, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, United States
- Bomback, Andrew S., Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Ahn, Wooin, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Radhakrishnan, Jai, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Canetta, Pietro A., Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Appel, Gerald B., Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
Background
Previous smaller retrospective and prospective studies have suggested that rituximab may be an effective therapy for adult patients with MCD and FSGS who have steroid dependent nephrotic syndrome.
Methods
We reviewed the charts of 82 adults seen at Columbia University Medical Center between 2014 to 2019 who received rituximab for treatment of MCD or FSGS. We analyzed clinical, biopsy, and laboratory data pre-infusion and at follow up (F/U). We categorized patients as frequently relapsing/steroid dependent (FRSD), infrequently relapsing (IR), steroid resistant (SR), and multi-drug resistant (MDR, failed 2 or more prior immunosuppressive medications(IS)) based on their clinical course.
Results
Of 80 patients biopsied, 41 patients had MCD, 34 had FSGS, 5 had podocytopathy associated with another diagnosis, 2 patients had nephrotic syndrome without previous biopsy. Median age was 40 years and 60% were male. 48 patients were Caucasian, 11 African-American, 17 Hispanic and 6 Asian. Disease categories included 41 FRSD, 7 IR, 9 SR and 25 MDR. The median duration of F/U was 30 months (range 1-156 months). 51/82 (62%) patients achieved complete remission (CR, UPCR <0.5 g/g) and 11/82(13%) achieved partial remission (PR, UPCR 0.5-3.5 g/g) at F/U. All CR/PR occurred by 7 months after infusion of rituximab. 20/82 (24%) did not achieve CR/PR. Of the 61 patients in CR/PR, 48 (79%) patients were off all other IS at F/U. 36/41(88%) FRSD patients achieved CR/PR, and while 11/25(44%) MDR patients achieved PR, none achieved CR. 13/82(16%) patients progressed to ESRD, 8/13(62%) of these patients were MDR. 25/82(30%) patients relapsed, median time to relapse was 22 months from last rituximab infusion. 18 patients were retreated with rituximab, and 13/18(72%) achieved CR.
Conclusion
This large study confirms the benefit of rituximab in achieving remission of proteinuria and reduction of immunosuppression in adults with MCD or FSGS. Patients with MDR disease were less likely to respond to rituximab.