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Kidney Week

Abstract: FR-PO671

Trends from 2010 to 2022 in the Utilization of Anti-CD20 Antibodies to Treat Childhood Nephrotic Syndrome

Session Information

  • Pediatric Nephrology - II
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Hirabayashi, Kathryn, The Children's Hospital of Philadelphia Division of General Pediatrics, Philadelphia, Pennsylvania, United States
  • Goodwin Davies, Amy, The Children's Hospital of Philadelphia Division of General Pediatrics, Philadelphia, Pennsylvania, United States
  • Razzaghi, Hanieh, The Children's Hospital of Philadelphia Division of General Pediatrics, Philadelphia, Pennsylvania, United States
  • Dharnidharka, Vikas R., St Louis Children's Hospital, St Louis, Missouri, United States
  • Dixon, Bradley P., University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States
  • Flynn, Joseph T., University of Washington Department of Pediatrics, Seattle, Washington, United States
  • Gluck, Caroline A., Nemours Children's Hospital Delaware, Wilmington, Delaware, United States
  • Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Smoyer, William E., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Background

A growing body of evidence supports the efficacy of the type I anti-CD20 monoclonal antibody, rituximab, in the management of children with frequently relapsing or steroid dependent nephrotic syndrome (NS). We examined trends in the use of anti-CD20 antibodies in a multi-institutional population of children with NS.

Methods

Data came from PEDSnet, a clinical research network that aggregates electronic health record (EHR) data at several children’s healthcare organizations (database version 4.8). Patients were aged 2-21.99 years, had ≥2 outpatient visits ≥1 year apart, and met our published EHR-based computable phenotype algorithm for nephrotic conditions between January 2010-November 2022. Children with systemic lupus erythematosus (SLE) or congenital or genetic nephrotic diagnoses were excluded. Treatments were measured from NS diagnosis to kidney transplant or most recent in-person encounter. We stratified the cohort by presence of native kidney biopsy.

Results

Among 6,880,824 patients across 6 centers, 3,021 met criteria for nephrotic conditions. 953 (32%) had at least one kidney biopsy. Rituximab utilization increased over time, with a sustained increase since 2019 from 5.9% to 7.8%. Similar trends were observed for mycophenolate and tacrolimus. Concurrently, use of cyclosporine and cyclophosphamide decreased. Tacrolimus was most frequently used.

Conclusion

Use of rituximab to manage NS has steadily increased. PEDSnet provides the ability to collect real-world data and enhance our understanding of long-term efficacy and trends in steroid-sparing medication use for rare diseases such as NS.

Drug exposure trends in NS patients; counts <11 not shown

Funding

  • NIDDK Support