Long Term Evaluations of First Single-dose Rituximab in Children with Steroid-Dependent Minimal-Change Nephrotic Syndrome.

OBJECTIVE

To explore the long-term efficacy and safety of the first single dose of rituximab in children with steroid-dependent minimal-change nephrotic syndrome (SD-MCNS) over a two-year period after infusion.

METHODS

A 2-year retrospective observational study was performed on children with SD-MCNS who received the first single dose of rituximab (375 mg/m2) from October 2011 to December 2018.

RESULTS

Seventy-seven patients (median age 8.17 years) were included. The efficacy of the first single-dose rituximab in children with SD-MCNS was 90.91% (70/77). An overall relapse rate of 78.33% was achieved. Older age at rituximab treatment onset (>8.46 years), a lower steroid-dependent dosage (<18.76 mg/m2·d) and a higher CD4+ T-cell count before rituximab treatment (>31.22%) were positively related to treatment efficacy (p < 0.05). Male sex, younger age at rituximab treatment onset, a higher IgE level before rituximab treatment, and a higher white blood cell count and CD3+ T-cell count at the time of steroid withdrawal were associated with disease relapse (p < 0.05). A model for predicting relapse after rituximab treatment in SD-MCNS patients was established.

CONCLUSIONS

The first single-dose rituximab treatment for children with SD-MCNS was effective and safe. Greater efficacy was observed in patients who were older at rituximab treatment onset, had a lower steroid-dependent dosage, or had a higher CD4+ T-cell count before rituximab treatment. In contrast, younger male patients with a higher IgE level experienced an increased occurrence of relapse.