• Anne-Laure Sellier-Leclerc, Marie-Alice Macher, Chantal Loirat, Valérie Guérin, Hervé Watier, Michel Peuchmaur, Véronique Baudouin, and Georges Deschênes.
• Pediatric Nephrology Department, Hôpital Robert Debré, APHP, Université Paris VII, 48 Boulevard Sérurier, 75019, Paris, France. alaure.leclerc@gmail.com
• Pediatr. Nephrol. 2010 Jun 1; 25 (6): 1109-15.

AbstractAlthough 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.

23 keywords...

hide…