Rituximab in maintaining remission in adults with podocytopathy. Issue 8 (14th June 2020) - Ramachandran, Raja
Abstract: Rituximab is currently used after the conventional agents have failed in the management of steroid‐dependent (SD)/ steroid‐resistant (SR) podocytopathies and have a safer toxicity profile. We report 53 adults with podocytopathies who were managed effectively with CD19‐targeted rituximab therapy. Methods: This was a prospective study carried out at a tertiary care centre in India between January 2014 and June 2019. Adults between 16 and 60 years with SD, frequently relapsing (FR), and SR nephrotic syndrome (NS) due to podocytopathy received rituximab in a CD19‐targeted approach. Primary outcome: Percentage of patients who were in remission at 6 and 12 months. Secondary outcome: Percentage of patients in remission at the last follow‐up, rituximab dose and adverse events of rituximab therapy. Results: Fifty‐three adults with SD/FR/SR NS received CD19‐targeted rituximab. The median age at the time of first rituximab injection was 30.09 ± 13.21 (16.53) years. At the time of first rituximab infusion, all patients were in remission with steroids and/or calcineurin inhibitors (CNIs). Fifty (94.33%) patients were in remission at the end of 6 and 12 months and the last follow‐up (median: 36 months). The mean total dose of rituximab at 1 year was 788.7 ± 128.1 (6 001 100) mg. At last follow‐up (median 36 months), 42 (79%) patients did not require any additional CNI or steroids therapy. No serious adverse events to rituximab were noted. Conclusion: CD19‐targeted rituximab therapy is safe and efficacious in the management of SD/SR adult podocytopathy. Also, rituximab is effective in maintaining remission in treatment naïve adult SD or FR podocytopathy. SUMMARY AT A GLANCE: Among 53 adult patients with podocytopathies, rituximab was safe in inducing remission in 22 patients with steroid‐dependent/steroid‐resistant disease, and effective as maintenance therapy in 23 patients who were treatment naïve or had frequently relapsing disease.