P DIKSHA1, A LE PAGE1,2, R KITCHING1,3,4, L M JOHNSTONE1,2
1Department of Nephrology, Monash Children’s Hospital, Clayton, Australia, 2Department of Paediatrics, Monash University, Clayton, Australia, 3Department of Medicine, Monash University, Clayton, Australia, 4Department of Nephrology, Monash Health, Clayton, Australia
Aim: To evaluate the use of rituximab in NS and assess its efficacy maintaining disease remission.
Background: Rituximab is a chimeric monoclonal antibody that is effective in treating children with nephrotic syndrome (NS) who demonstrate frequent relapses, resistance, or adverse effects to conventional immunosuppression.
Methods: We conducted a single-centre retrospective audit evaluating patients <18 years with NS, who received rituximab between 2010-2020. Patients who achieved complete remission with glucocorticoids alone or calcineurin inhibitors (CNI) but subsequently relapsed or were medication-dependent were included. We assessed the effect of rituximab in maintaining disease remission, reducing use of other immunosuppressants and any adverse events.
Results: All 14 patients were in remission and 13 of 14 were taking at least 1 immunosuppressant when they received rituximab. Of these, 10 were steroid-responsive, and 4 achieved remission with the addition of CNI. Prior to rituximab use, patients had a median of 8.0 relapses (range 5-25), and had received treatment with a median of 2 (range 0-3) alternative immunosuppressants. Median number of rituximab doses was 2.5 (range 1-6) over a median duration of 9 months (range 0-57). Adverse events were reported in 2 patients. Rituximab was effective at maintaining remission in 87% of patients at 3 months (n=14), 86% at 6 months (n=13), 75% at 12 months (n=11) and 78% at 24 months (n=9). After commencing rituximab, 12 of 13 patients ceased all other immunosuppression, within a median of 6 months (range 0-66).
Conclusions: Rituximab therapy is associated with a prolonged relapse-free period in children with NS over a 2 year follow-up period. Its use could be considered earlier in the treatment course of NS to improve maintenance of disease remission.
Dr Prerna Diksha is a Victorian Paediatric Basic Physician Trainee, with an interest in paediatric nephrology and clinical research.