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Abstract: PO1870

Clinical Predictors of Response to Rituximab in the Nephrotic Syndrome Study Network (NEPTUNE) Cohort

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Levy Erez, Daniella, Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Meyers, Kevin E.C., Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Zee, Jarcy, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Smith, Abigail R., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Rituximab, an anti CD20 monoclonal antibody, is one of the alternative medications offered to children and adults with Nephrotic syndrome. Despite the growing knowledge regarding this medication, there are still concerns regarding long-term safety that need to be considered prior to initiation of therapy. Given these risks there is a need to identify characteristics of patients who will respond best to rituximab therapy.

Methods

We identified all patients who received rituximab within NEPTUNE, a prospective study of adults and children with glomerular disease enrolled at the time of first biopsy or at initial presentation.Remission was defined as UPCR<0.3 mg/mg after rituximab initiation. Kaplan-Meier plots and log-rank tests were used to compare the probability of response among various levels of demographic and clinical variables.

Results

Of 734 patients enrolled in NEPTUNE, 57 (34 adult, 23 pediatric) received rituximab after enrollment and were eligible for analysis. In the adult cohort, average age at initiation was 45.8 (SD=15.4), majority were male (79%) and white (88%) and diagnosed with membranous nephropathy (MN) (74%). In the pediatric cohort, most had Minimal change disease (MCD) disease on biopsy or nephrotic syndrome not specified (not biopsied) (NSNS) (83%), mean age was 6.96 yrs (SD=4.25), 57% were male, and 74% were white. Remission was achieved in 18 (53%) adults and children 19 (83%) respectively, with median time to remission of 25.4 months and 4.8 months respectively. Probability of achieving remission was higher in patients with MCD/NSNS compared to MN (p<0.001, Figure). Among patients with MCD/NSNS, probability of remission was higher in <6 yrs. vs. ≥6 yrs. and adults (p=0.036).

Conclusion

Rituximab response rate in patients with MCD/NSNS were higher and quicker than in those with MN. Young children with MCD/MSNS had the highest rates of response.Future work is now targeted at identifying additional biomarkers (specifically lymphocyte profile) to predict response to rituximab.

Figure: Remission probability by age and disease diagnosis.

Funding

  • NIDDK Support