Rituximab treatment for relapsing minimal change disease and focal segmental glomerulosclerosis
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Rituximab treatment for relapsing minimal change disease and focal segmental glomerulosclerosis : a systematic review. / Kronbichler, Andreas; Kerschbaum, Julia; Fernandez-Fresnedo, Gema; Hoxha, Elion; Kurschat, Christine E; Busch, Martin; Bruchfeld, Annette; Mayer, Gert; Rudnicki, Michael.
In: AM J NEPHROL, Vol. 39, No. 4, 2014, p. 322-30.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Rituximab treatment for relapsing minimal change disease and focal segmental glomerulosclerosis
T2 - a systematic review
AU - Kronbichler, Andreas
AU - Kerschbaum, Julia
AU - Fernandez-Fresnedo, Gema
AU - Hoxha, Elion
AU - Kurschat, Christine E
AU - Busch, Martin
AU - Bruchfeld, Annette
AU - Mayer, Gert
AU - Rudnicki, Michael
PY - 2014
Y1 - 2014
N2 - BACKGROUND: Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) remain a therapeutic challenge, since steroids and other immunosuppressive agents exhibit an unfavorable adverse event spectrum. The aim of this review was to systematically summarize and analyze data from preexisting studies reporting the outcome of rituximab (RTX) treatment in these patients.METHODS: Study data on adult patients with either steroid-dependent or frequently relapsing MCD/FSGS were identified by a PubMed and Embase search. The number of relapses was calculated and the use of immunosuppressive co-medication prior to and after RTX treatment was quantified.RESULTS: We identified 14 studies including 86 patients with frequently relapsing and steroid-dependent MCD or FSGS. Treatment with RTX reduced the number of relapses per year from 1.3 (0-9) relapses prior to treatment compared to 0 (0-2) after therapy (p < 0.001). Proteinuria decreased from 2.43 (0-15) g/day to 0 (0-4.89) g/day (p < 0.001), while serum albumin increased from 2.9 (1.2-4.6) at baseline to 4.0 (1.8-5.09) g/l after RTX (p = 0.001). The use of immunosuppression used at the time of RTX administration was also reduced after RTX therapy (p < 0.001). Baseline serum albumin was lower (p = 0.018), whereas the number of immunosuppressants prior to RTX was higher (p = 0.018) in patients with relapse after RTX.CONCLUSIONS: The published data suggest that RTX is effective in reducing the number of relapses and sparing immunosuppression in frequently relapsing and steroid-dependent nephrotic syndrome due to MCD and FSGS. These promising findings have to be confirmed in controlled and prospective studies.
AB - BACKGROUND: Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) remain a therapeutic challenge, since steroids and other immunosuppressive agents exhibit an unfavorable adverse event spectrum. The aim of this review was to systematically summarize and analyze data from preexisting studies reporting the outcome of rituximab (RTX) treatment in these patients.METHODS: Study data on adult patients with either steroid-dependent or frequently relapsing MCD/FSGS were identified by a PubMed and Embase search. The number of relapses was calculated and the use of immunosuppressive co-medication prior to and after RTX treatment was quantified.RESULTS: We identified 14 studies including 86 patients with frequently relapsing and steroid-dependent MCD or FSGS. Treatment with RTX reduced the number of relapses per year from 1.3 (0-9) relapses prior to treatment compared to 0 (0-2) after therapy (p < 0.001). Proteinuria decreased from 2.43 (0-15) g/day to 0 (0-4.89) g/day (p < 0.001), while serum albumin increased from 2.9 (1.2-4.6) at baseline to 4.0 (1.8-5.09) g/l after RTX (p = 0.001). The use of immunosuppression used at the time of RTX administration was also reduced after RTX therapy (p < 0.001). Baseline serum albumin was lower (p = 0.018), whereas the number of immunosuppressants prior to RTX was higher (p = 0.018) in patients with relapse after RTX.CONCLUSIONS: The published data suggest that RTX is effective in reducing the number of relapses and sparing immunosuppression in frequently relapsing and steroid-dependent nephrotic syndrome due to MCD and FSGS. These promising findings have to be confirmed in controlled and prospective studies.
KW - Antibodies, Monoclonal, Murine-Derived
KW - Antirheumatic Agents
KW - Glomerulosclerosis, Focal Segmental
KW - Humans
KW - Nephrosis, Lipoid
KW - Recurrence
KW - Rituximab
KW - Journal Article
KW - Review
U2 - 10.1159/000360908
DO - 10.1159/000360908
M3 - SCORING: Journal article
C2 - 24751753
VL - 39
SP - 322
EP - 330
JO - AM J NEPHROL
JF - AM J NEPHROL
SN - 0250-8095
IS - 4
ER -