Long Term Evaluations of First Single-dose Rituximab in Children with Steroid-Dependent Minimal-Change Nephrotic Syndrome
Xiao-Ling Niu,
Yun-Fan Gu,
Dan Feng,
Sheng Hao,
Xin-Yu Kuang,
Ping Wang,
Wen-Yan Huang
Affiliations
Xiao-Ling Niu
Department of Nephrology, Rheumatology and Immunology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Yun-Fan Gu
Department of Nephrology, Rheumatology and Immunology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Dan Feng
Department of Nephrology, Rheumatology and Immunology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Sheng Hao
Department of Nephrology, Rheumatology and Immunology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Xin-Yu Kuang
Department of Nephrology, Rheumatology and Immunology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Ping Wang
Department of Nephrology, Rheumatology and Immunology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Wen-Yan Huang
Department of Nephrology, Rheumatology and Immunology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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 (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.
