Rituximab Little Use in Resistant Idiopathic Nephrotic Syndrome

Drug does not reduce proteinuria in combination with prednisone, calcineurin inhibitors

FRIDAY, May 11 (HealthDay News) -- The anti-CD20 monoclonal antibody, rituximab, added to prednisone and calcineurin inhibitors, does not provide any additional benefit in terms of reduced proteinuria in the treatment of children with resistant idiopathic nephrotic syndrome (INS), according a study published online May 10 in the Journal of the American Society of Nephrology.

Alberto Magnasco, M.D., of the IRCCS Giannina Gaslini Children's Hospital in Genoa, Italy, and colleagues conducted an open-label, randomized, controlled trial involving 31 children aged 2 to 16 years with INS unresponsive to prednisone plus calcineurin inhibitors to investigate whether rituximab has any efficacy in these patients. All patients continued receiving prednisone and calcineurin inhibitors, and one group received adjuvant rituximab.

The researchers found that the children receiving rituximab did not have a statistically significant reduction in proteinuria at three months (change, −12 percent; P = 0.77 in a covariance model adjusted for baseline proteinuria). The results were not altered after further adjustment for previous remission and interaction terms.

"In conclusion, our study suggests that rituximab is not effective in forms of INS resistant to steroids and calcineurin inhibitors," the authors write. "This seems to be especially true in children with INS who never responded to standard drugs. Further studies may be necessary in children with delayed-resistant forms of INS."

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