Nephrotic Syndrome Treatment

Steroids are common in the treatment of Nephrotic Syndrome. Although its therapeutic effect is obvious in reducing proteinuria, not all patients are steroid-sensitive. And steroids have a lot of side effects.

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Rituximab Can Replace Steroid and Reduce the Relapse of Nephrotic Syndrome

2018-10-20 03:45

Rituximab Can Replace Steroid and Reduce the Relapse of Nephrotic SyndromeSteroids are common in the treatment of Nephrotic Syndrome. Although its therapeutic effect is obvious in reducing proteinuria, not all patients are steroid-sensitive. And steroids have a lot of side effects.

Children are also at high risk of Nephrotic Syndrome. Most of the children have a high response to steroids, but nearly 40% of the patients will become dependent after using steroids, leading to relapse upon discontinuation of drugs.

Therefore, we are all eager for a new drug to play the role of anti-inflammation, lower proteinuria, inhibit immune reaction and reduce renal damage. Which drug can replace steroids to play the role of immunosuppressant?

At present, the first choice of drugs without glucocorticoid is calcineurin inhibitor (CNI). However, the efficacy of CNI is affected by patients, and such drugs have renal toxicity, neurotoxicity and the risk of diabetes, which should be closely monitored when used.

How to deal with this situation?

This impasse was broken by a recent study that showed that b-lymphocyte scavenger rituximab could be used to treat patients with calcineurin inhibitor (CNI) tacrolimus intolerance.

The Biswanath Basu research group from India conducted a randomized controlled trial:

Research project: to compare the effectiveness of rituximab and tacrolimus in maintaining recurrent surial in children with nephrotic syndrome.

Study subjects: 120 children with nephrotic syndrome, with an average age of 7 years and an average illness course of 2 years.

Study procedures: patients were randomly assigned to receive tacrolimus combined with prednisone every other day and rituximab alone (n= 60,375mg /m2, 2 courses) for 12 months.

Research findings:

The 12-month recurrence survival rate of rituximab monotherapy group was significantly lower than that of tacrolimus group. The former is 90% without recurrence rate, the latter is 63%. Patients on rituximab had an 88 percent lower risk of recurrent nephrotic syndrome than those on tacrolimus.

In addition, other indicators such as serum albumin levels in the rituximab group were higher than those in the tacrolimus group, blood cholesterol levels in the rituximab group were lower than those in the tacrolimus group, and the estimated glomerular filtration rate of the rituximab group was higher. And the combined use of steroids was different during the use of these two drugs. 93.2% of the patients taking rituximab did not use hormones, and 79.3% of the patients taking tacrolimus did not use hormones. Thus, the administration of rituximab can significantly reduce the hormone dependence of patients with nephrotic syndrome.

Adverse reactions were higher in the tacrolimus group, where the incidence of infection was twice as high in the tacrolimus group as in the rituximab group.

In general, rituximab has good tolerance, low recurrence rate and low renal toxicity in children with nephrotic syndrome, which can be considered as a first-line drug to treat nephrotic syndrome as an alternative or to reduce steroids.

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