The efficacy and safety of rituximab in adult patients with steroid-dependent or frequent relapsing nephrotic syndrome: A retrospective study.

BACKGROUND

Steroid-dependent (SD) and frequently relapsing (FR) nephrotic syndrome, primarily due to minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS), poses significant treatment challenges. This study evaluates the efficacy and safety of rituximab in these patient populations.

METHODS

We conducted a retrospective study of 94 patients with SD or FR nephrotic syndrome treated with rituximab. Clinical outcomes, including remission rates and relapse frequency, were assessed alongside B lymphocyte counts and anti-nephrin antibody detection.

RESULTS

Among the cohort, 88.3 % had MCD and 11.7 % had FSGS. Each patient received a median of 3 (IQR: 2, 4) infusions with a median total dose of 1700 (IQR: 1000, 2500) mg rituximab. All patients achieved clinical remission, with 87.2 % attaining complete remission. The median time to remission was 1.5 months. Relapse rates decreased significantly to 30.9 %, from a median of 4 relapses to 0 after treatment (P < 0.001). The median relapse-free duration extended to 50 months. Anti-nephrin antibodies were detected in 76.2 % of tested patients, suggesting a potential biomarker for SD/FR nephrotic syndrome. Rituximab was well tolerated, with mild adverse events observed.

CONCLUSIONS

Rituximab is an effective and safe therapeutic option for patients with SD or FR nephrotic syndrome due to MCD or FSGS. Further studies are warranted to optimize treatment protocols and investigate the role of biomarkers in predicting treatment response.