Rituximab efficiency in children with steroid-dependent nephrotic syndrome (original) (raw)

Abstract

Although most patients with idiopathic nephrotic syndrome (NS) respond to steroid treatment, development of steroid dependency may require a long-term multidrug therapy including steroid and calcineurin inhibitor. Rituximab was shown to allow a reduction of the doses of steroid and immunosuppressive drugs in those patients. In the present series, 22 patients with steroid-sensitive, but steroid-dependent nephrotic syndrome were treated with rituximab. Rituximab reduced B cell count down to an undetectable level in all patients. A second treatment was necessary in 18 patients in order to maintain B cell depletion for up to 18 months. B cell depletion lasted 4.9 to 26 months (mean 17.2 months). At last follow-up, 9 patients were in remission without oral steroid or calcineurin inhibitor, although B cell count had recovered for 2.9 to 17 months (mean 9.5 months). A remission under ongoing B cell depletion was observed in 10 other patients in the absence of oral steroid or calcineurin inhibitor. Rituximab failed in 2 patients and 1 refused any additional treatment, despite B cell recovery and relapse. Toxicity of rituximab was limited to reversible cytokine shock in 2 patients and reversible neutropenia in 1 patient. No severe infection was observed.

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Authors and Affiliations

  1. Pediatric Nephrology Department, Hôpital Robert Debré, APHP, Université Paris VII, 48 Boulevard Sérurier, 75019, Paris, France
    Anne-Laure Sellier-Leclerc, Marie-Alice Macher, Chantal Loirat, Michel Peuchmaur, Véronique Baudouin & Georges Deschênes
  2. Laboratory of Immunology, Hôpital Robert Debré, APHP, Université Paris VII, Paris, France
    Valérie Guérin
  3. Laboratory of Immunology, Pilot Centre for the Monitoring of Therapeutic Antibodies, CHRU Tours, Tours, France
    Hervé Watier

Authors

  1. Anne-Laure Sellier-Leclerc
  2. Marie-Alice Macher
  3. Chantal Loirat
  4. Valérie Guérin
  5. Hervé Watier
  6. Michel Peuchmaur
  7. Véronique Baudouin
  8. Georges Deschênes

Corresponding author

Correspondence toAnne-Laure Sellier-Leclerc.

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Sellier-Leclerc, AL., Macher, MA., Loirat, C. et al. Rituximab efficiency in children with steroid-dependent nephrotic syndrome.Pediatr Nephrol 25, 1109–1115 (2010). https://doi.org/10.1007/s00467-010-1465-6

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