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Abstract: SA-PO707

Rituximab and a Short Course of Corticosteroids for Initial Management of Adult-Onset Minimal Change Disease

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Ositelu, Ayotunde, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Yamani, Fatmah Najeeb, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Amari, Kana R., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Kanwar, Yashpal S., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Aggarwal, Vikram, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
Background

Minimal change disease (MCD) accounts for 10-25 % of adult nephrotic syndrome (NS). Despite corticosteroid (CS) sensitive course of NS in MCD, high doses and prolonged exposure lead to many CS-related adverse effects. Rituximab (RTX) has proven to be effective in frequently relapsing (FR) and CS-dependent (SD) MCD. We report our experience of using RTX and a short course of CS for the initial management of the first episode of adult-onset MCD with the intention to curtail the duration and cumulative dose of CS.

Methods

Our series includes 5 adult patients with biopsy-proven MCD from February 2018 to March 2022 at Northwestern Memorial Hospital, Chicago, Illinois. Management plans were based on shared decisions with patients regarding the risks and benefits of various treatment options, the evolution of adverse effects, and the course of NS. All patients were initially treated with high-dose prednisone (1mg/kg/day) and two infusions of RTX (2-4 week intervals). Relapse, partial and complete remission (PR, CR) were defined per the KDIGO 2021 Glomerular Diseases Guideline.

Results

The mean age of the patients was 46 years (range 32-79), all females. The mean duration of initial high-dose CS was 3.2 weeks and followed by CS taper. The total mean duration of CS use was 8.6 weeks (range 6-12 weeks). All patients received the first dose of RTX within 4 weeks of CS initiation. CR was achieved in all patients at a mean time of 9.4 weeks (range 2-24 weeks, Figure 1). All patients expressed reluctance to a long duration of CS as per KDIGO as they experienced CS-related adverse events. All patients maintained CR for one year. Only 2 patients had relapsed after 1 year and responded to a single dose of Rituximab alone. No patient experienced severe adverse events from RTX.

Conclusion

Our study is promising and indicates that RTX may be a viable candidate as first-line therapy for treating MCD in adults. This approach limits the cumulative dose of CS and maintains remission at 1 year with overall limited side effects and better patient-reported outcomes.

Course of Adult-Onset MCD for Five Patients Over 1 Year