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Kidney Week

Abstract: SA-PO907

Obinutuzumab in Treatment-Resistant Primary Focal Segmental Glomerulosclerosis (FSGS): A Report of Four Cases

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Radhakrishnan, Yeshwanter, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Sethi, Amit, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

There is no definite approach in treating patients with primary FSGS who fail to respond to immunosuppressive (IS) therapy including corticosteroids and calcineurin inhibitors. Other IS therapy such as rituximab (RTX), Acthar gel and mycophenolate have been use with sub-optimal response. Obinutuzumab is type II anti-CD20 monoclonal antibody that has been shown to be effective in treating patients who have been resistant to RTX in diseases such as ANCA associated vasculitis or membranous nephropathy.

Methods

We report 4 patients with treatment-resistant primary FSGS with negative genetic testing who were treated successfully with obinutuzumab. They were treated with an average of 4 other IS with sub-optimal response as shown in Table 1.

Results

The mean age was 48 years and 50% were males. The mean serum creatinine and mean serum albumin at the time of presentation was 2.2 mg/dL and 2.0 g/dL respectively. The mean proteinuria at the time of diagnosis and before initiation of obinutuzumab was 10.7 g/24 hours and 7.6 g/24 hours respectively. The mean proteinuria at 6 and 12 months after the infusion was 1.6 g/24 hours and 1.7 g/24 hours respectively. Mean serum albumin improved to a mean of 4.0 g/dL and 4.3 g/dL at 6 months and 12 months respectively. None of the patients experienced any adverse effects or infusion reactions. CD20+ B cells remained depleted over an average of 10.5 months.

Conclusion

We report 4 cases of treatment-resistant primary FSGS that were treated successfully with obinutuzumab infusions with 1 complete remission and 3 partial remissions. The efficacy of Obinutuzumab on treatment-resistant FSGS should be evaluated through a randomized clinical trial to determine short- and long-term outcomes and adverse effects.