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Rituximab treatment combined with methylprednisolone pulse therapy and immunosuppressants for childhood steroid-resistant nephrotic syndrome

Kamei, Koichi ; Okada, Mari ; Sato, Mai ; Fujimaru, Takuya ; Ogura, Masao ; Nakayama, Makiko ; Kaito, Hiroshi ; Iijima, Kazumoto ; Ito, Shuichi

Pediatric nephrology (Berlin, West), 2014-07, Vol.29 (7), p.1181-1187 [Periódico revisado por pares]

Berlin/Heidelberg: Springer Berlin Heidelberg

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Título:
Rituximab treatment combined with methylprednisolone pulse therapy and immunosuppressants for childhood steroid-resistant nephrotic syndrome
Autor: Kamei, Koichi ; Okada, Mari ; Sato, Mai ; Fujimaru, Takuya ; Ogura, Masao ; Nakayama, Makiko ; Kaito, Hiroshi ; Iijima, Kazumoto ; Ito, Shuichi
Assuntos: Adolescent ; Adverse events ; Antibodies, Monoclonal, Murine-Derived - administration & dosage ; Antibodies, Monoclonal, Murine-Derived - adverse effects ; Calcineurin ; Calcineurin inhibitors ; Child ; Child, Preschool ; Children ; Complications and side effects ; Diseases ; Dosage and administration ; Drug Resistance ; Drug therapy ; Drug Therapy, Combination ; End-stage renal disease ; Female ; Humans ; Immunosuppression ; Immunosuppressive agents ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - adverse effects ; Intravenous administration ; Kidney diseases ; Male ; Medicine ; Medicine & Public Health ; Methylprednisolone ; Methylprednisolone - administration & dosage ; Methylprednisolone - adverse effects ; Nephrology ; Nephrotic syndrome ; Nephrotic Syndrome - drug therapy ; Original Article ; Patient outcomes ; Patients ; Pediatrics ; Prognosis ; Proteinuria ; Remission ; Renal failure ; Renal function ; Rituximab ; Steroids ; Urology
É parte de: Pediatric nephrology (Berlin, West), 2014-07, Vol.29 (7), p.1181-1187
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
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Descrição: Background Calcineurin inhibitors (CIs) with/without intravenous methylprednisolone pulse therapy (MPT) constitute the standard treatment for childhood-onset, steroid-resistant nephrotic syndrome (SRNS). However, some patients fail to achieve remission. We treated SRNS patients resistant to CIs and MPT with additional rituximab combined with MPT and immunosuppressive agents. Methods Ten patients (aged 2–14 years) with CI- and MPT-resistant SRNS were enrolled. Patients were administered rituximab (1–4 doses; 375 mg/m 2 ) followed by MPT (30 mg/kg/day of methylprednisolone for 3 consecutive days) once every 2–4 weeks until complete remission (CR). We analyzed clinical outcome and safety. Results Six patients received a single dose of rituximab, 2 received two doses, and 2 received four doses. Seven patients achieved CR, 1 achieved partial remission, and 2 showed no response. Although 2 patients with no response progressed to end-stage renal failure, 7 patients with CR preserved normal renal function without proteinuria at the last observation. There were two serious adverse events. Conclusions Additional rituximab combined with conventional MPT and immunosuppressive agents is a promising option for overcoming refractory SRNS. Aggressive B cell suppression by rituximab may ameliorate resistance to conventional treatments and a cocktail of other immunosuppressive agents, such as CIs, MMF, mizoribine, may be beneficial. However, as intense immunosuppression may cause serious adverse events, further evaluation is necessary.
Editor: Berlin/Heidelberg: Springer Berlin Heidelberg
Idioma: Inglês

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Rituximab treatment combined with methylprednisolone pulse therapy and immunosuppressants for childhood steroid-resistant nephrotic syndrome

Kamei, Koichi ; Okada, Mari ; Sato, Mai ; Fujimaru, Takuya ; Ogura, Masao ; Nakayama, Makiko ; Kaito, Hiroshi ; Iijima, Kazumoto ; Ito, Shuichi

Berlin/Heidelberg: Springer Berlin Heidelberg

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