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Rituximab Treatment in Nephrotic Syndrome

Rituximab Treatment in Nephrotic Syndrome . ESPN 2009. Rituximab . Chimeric anti-CD20 monoclonal antibody Reduction in B cell proliferation Rx of lymphoma First used in NS patients with ITP or lymphoma NS only a T-cell disease?? Only 73 cases published. French Rituximab study .

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Rituximab Treatment in Nephrotic Syndrome

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  1. Rituximab Treatment in Nephrotic Syndrome ESPN 2009

  2. Rituximab • Chimeric anti-CD20 monoclonal antibody • Reduction in B cell proliferation • Rx of lymphoma • First used in NS patients with ITP or lymphoma • NS only a T-cell disease?? • Only 73 cases published

  3. French Rituximab study • Objectives: • To achieve sustained remission in severe SD-NS and avoid toxicity of other steroid-sparing agents • To induce remission in SR or cyclosporin-resistant NS patients • 100 children • 75 analysed • 41 > 18 mths follow-up

  4. Rituximab • 1-4 injections of 375mg/m² • All achieved complete B cell depletion

  5. Duration of Remission • Dependent on B cell depletion duration • Independent of associated immunosuppression after Ritux (none, MMF, Tac, CyA, Pred)

  6. Long term efficacy • 39 patients • Mean follow-up 26 mo (18-48) • 11 (28%) – No relapse • 23 relapsed on reappearance of CD20 cells • Most did not relapse after 2nd injection

  7. Adults with SD NS • 9 adults • Long term remission: • 1/3 remain well • 2/3 relapsed, but needed less IS

  8. Rituximab in SR NS • Ritux given in nephrotic state • Associated IS • B-cell depletion not always achieved even after 4 courses • Efficacy better in 2° SR, rather than 1°SR NS.

  9. Rituximab: Side effects • 1/3 patients experienced • Minor • Hypotension (7), fever, rash (6) • Delayed • Severe: 1 death (pulmonary fibrosis) • Transient neutropenia (2) • Infection (3) • Papilloedema (1) • Connective tissue disease (1)

  10. Rituximab – Long term rx • Number of reinjections? • Risk of progressive multifocal leucoencephalopathy (PML)?

  11. Rituximab – conclusions • Mechanism of action speculative • Immediate effect • Better if used in remission • Relapses can occur during B cell depletion and at reappearance of B cells • Relapses not correlated to B cell count • Late effects unclear • B cell role in idiopathic NS?

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