Abstract: FR-PO0942
Maintenance Immunosuppression After Rituximab in Children with Frequently Relapsing or Steroid-Dependent Nephrotic Syndrome: A Meta-Analysis
Session Information
- Pediatric Nephrology: Genetic Diseases, Development, Neonatal Nephrology, Glomerular Diseases, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Vendas Rodrigues Neto, Ruy Tamoyo, Universidade Federal do Rio de Janeiro Instituto de Puericultura e Pediatria Martagao Gesteira, Rio de Janeiro, RJ, Brazil
- Dos Santos, Renata Silva Duarte, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
- Cabral, Tayenne Do Vale, Sociedade Beneficente Israelita Brasileira Albert Einstein, São Paulo, SP, Brazil
- Leite, Marina de Assis Bezerra Cavalcanti, Universidade Federal da Paraiba, João Pessoa, PB, Brazil
- Lemanski, Ana Carolina, Centro Universitario de Varzea Grande, Várzea Grande, MT, Brazil
- Mesquita, Carolina B., Universidade de Mogi das Cruzes, Mogi das Cruzes, SP, Brazil
- Mussi, Michelle, Universidade Estadual de Londrina, Londrina, PR, Brazil
Background
The majority of children with idiopathic nephrotic syndrome achieve complete remission with corticosteroids. However, approximately half of these develop frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS). Rituximab (RTX) is an established therapy for childhood-onset SDNS/FRNS, yet most patients relapse after peripheral B-cell recovery. This study evaluated whether maintenance immunosuppression following RTX reduces relapse rates in children with SDNS/FRNS.
Methods
A systematic search identified RCTs and observational studies comparing maintenance immunosuppression after RTX versus RTX monotherapy in children with SDNS/FRNS. The primary outcome was relapse rate; the secondary outcome was peripheral B-cell recovery time. Statistical analysis followed Cochrane Collaboration guidelines and PRISMA recommendations. Risk of bias was assessed using the Cochrane Risk of Bias 1 tool; heterogeneity was evaluated using the Cochran Q test and I2 statistic.
Results
The analysis included 1 RCT and 4 observational studies (376 children receiving maintenance immunosuppression after RTX; 294 receiving RTX monotherapy). Maintenance immunosuppression after RTX significantly reduced relapse rates (HR 0.35; 95% CI 0.17–0.72; p = 0.004; I2 = 66%) without affecting peripheral B-cell recovery (MD 0.02; 95% CI −0.03–0.07; p = 0.45; I2 = 0%).
Conclusion
Maintenance immunosuppression following RTX significantly reduces relapses in children with SDNS/FRNS. While the analysis consisted predominantly of observational data and subgroup analysis of RCTs alone was not feasible due to limited randomized evidence, all included studies demonstrated consistent benefit of maintenance therapy in reducing relapses.
Figure 1. Forest plot of the primary outcome: Relapse Rate.
Figure 2. Forest plot of the secondary outcome: Recovery of B-cell count.