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Abstract: SA-PO709

Repetitive Administration of Rituximab to Maintain Clinical Remission in Patients With Minimal Change Disease/Focal Segmental Glomerulosclerosis

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Osterholt, Thomas, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
  • Kuehne, Lucas, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
  • Grundmann, Franziska, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
  • Benzing, Thomas, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
  • Volker, Linus A., Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
  • Brinkkoetter, Paul T., Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
Background

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are glomerulopathies that
present with nephrotic syndrome and show foot process effacement on electron microscopy. Primary forms of
these diseases are treated with immunosuppressive drugs such as steroids, calcineurin inhibitors, and cytotoxic
agents. Particular problems are frequent relapsing or glucocorticoid-dependent forms of those diseases. A
recent metaanlaysis provided evidence for the efficacy of B-cell depleting agents such as rituximab (RTX) in such
patients. However, there is little evidence for the efficacy of reinduction of remission after initial successful
treatment with RTX.

Methods

We conducted a single-center retrospective case series to evaluate the efficacy of
repeated induction therapies with rituximab in patients with primary mimimal change disease and focal
segmental glomerulosclerosis. We identified 13 patients who received more than one induction therapy with RTX from our
institutions and the FOrMe-registry (NCT03949972). Disease status prior to induction and after 3 and 6 months was
assessed. Changes in serum creatinine, proteinuria and time to relapse were evaluated. Relapse-free survival
was assessed with the cox proportional hazard and Kaplan Meier estimators and compared to previous therapy
regimens.

Results

Through all additional cycles after the first treatment with RTX, an improvement of disease
activity could be shown and led to a complete remission in 71% and partial remission in 27% after 3
(p<0.001) and 6 months (p<0.001) compared to the disease state before induction. Time to relapse increased
from 4.5 months (95%-CI: 3-10 months) to 21 months (95%-CI: 15-32 months) (p<0.001) compared to
previous immunosuppression regimen. The estimated glomerular filtration rate remained stable through all
cycles (p=0.53). Compared to continuous B-cell depletion, an individualized relapse based approach led to a
signicantly reduced rituximab exposure.

Conclusion

Repeated administration of RTX in patients with MCD/FSGS with an initial good clinical
response did not result in drug tolerance and decreased efficacy at a median follow-up of 93.5 months after the
first RTX induction. Thus, reinduction therapies may provide an alternative to continuous B-cell-depletion
and reduce long-term side effects of continuous immunosuppression.

Funding

  • Government Support – Non-U.S.