Rituximab is a safe and effective long-term treatment for children with steroid and calcineurin inhibitor-dependent idiopathic nephrotic syndrome

Pietro Ravani, Alessandro Ponticelli, Chiara Siciliano, Alessia Fornoni, Alberto Magnasco, Felice Sica, Monica Bodria, Gianluca Caridi, Changli Wei, Mirco Belingheri, Luciana Ghio, Sandra M Merscher-gomez, Alberto Edefonti, Andrea Pasini, Giovanni Montini, Corrado Murtas, Xiangyu Wang, Daniel Muruve, Augusto Vaglio, Davide Martorana & 4 others Antonello Pani, Francesco Scolari, Jochen Reiser, Gian M. Ghiggeri

Research output: Contribution to journalArticle

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Abstract

In children with idiopathic nephrotic syndrome, rituximab can maintain short-term remission with withdrawal of prednisone and calcineurin inhibitors. Long-term effects including the number of repeated infusions to maintain remission are unknown. To test this, we treated 46 consecutive children with idiopathic nephrotic syndrome lasting for at least 1 year (mean 6.3 years), maintained in remission with oral prednisone and calcineurin inhibitors. They received 1-5 rituximab courses during a median follow-up of 3 years. Oral agents were tapered after each infusion, and completely withdrawn within 45 days. Rituximab was well tolerated. Six-month probabilities of remission were 48% after the first infusion and 37% after subsequent infusions. One-and 2-year-remission probabilities were, respectively, 20 and 10%. Median time intervals between complete oral-agent withdrawal and relapse were 5.6 and 8.5 months, respectively, following the first and subsequent courses. The time to reconstitution of CD20 cells correlated with the duration of remission, but was not associated with variation in FcyR, CD20, or SMPDL-3B polymorphisms. Podocyte Src phosphorylation was normal. Thus, rituximab can be safely and repeatedly used as a prednisone and calcineurin inhibitor-sparing therapy in a considerable proportion of children with dependent forms of idiopathic nephrotic syndrome. Further study is needed to identify patients who will benefit most from rituximab therapy.

Original languageEnglish
Pages (from-to)1025-1033
Number of pages9
JournalKidney International
Volume84
Issue number5
DOIs
StatePublished - Nov 1 2013

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Steroids
Prednisone
Therapeutics
Podocytes
Phosphorylation
Calcineurin Inhibitors
Congenital Nephrosis
Rituximab
Recurrence

Keywords

  • clinical trial
  • nephrotic syndrome
  • pediatrics
  • proteinuria

ASJC Scopus subject areas

  • Nephrology

Cite this

Rituximab is a safe and effective long-term treatment for children with steroid and calcineurin inhibitor-dependent idiopathic nephrotic syndrome. / Ravani, Pietro; Ponticelli, Alessandro; Siciliano, Chiara; Fornoni, Alessia; Magnasco, Alberto; Sica, Felice; Bodria, Monica; Caridi, Gianluca; Wei, Changli; Belingheri, Mirco; Ghio, Luciana; Merscher-gomez, Sandra M; Edefonti, Alberto; Pasini, Andrea; Montini, Giovanni; Murtas, Corrado; Wang, Xiangyu; Muruve, Daniel; Vaglio, Augusto; Martorana, Davide; Pani, Antonello; Scolari, Francesco; Reiser, Jochen; Ghiggeri, Gian M.

In: Kidney International, Vol. 84, No. 5, 01.11.2013, p. 1025-1033.

Research output: Contribution to journalArticle

Ravani, P, Ponticelli, A, Siciliano, C, Fornoni, A, Magnasco, A, Sica, F, Bodria, M, Caridi, G, Wei, C, Belingheri, M, Ghio, L, Merscher-gomez, SM, Edefonti, A, Pasini, A, Montini, G, Murtas, C, Wang, X, Muruve, D, Vaglio, A, Martorana, D, Pani, A, Scolari, F, Reiser, J & Ghiggeri, GM 2013, 'Rituximab is a safe and effective long-term treatment for children with steroid and calcineurin inhibitor-dependent idiopathic nephrotic syndrome', Kidney International, vol. 84, no. 5, pp. 1025-1033. https://doi.org/10.1038/ki.2013.211
Ravani, Pietro ; Ponticelli, Alessandro ; Siciliano, Chiara ; Fornoni, Alessia ; Magnasco, Alberto ; Sica, Felice ; Bodria, Monica ; Caridi, Gianluca ; Wei, Changli ; Belingheri, Mirco ; Ghio, Luciana ; Merscher-gomez, Sandra M ; Edefonti, Alberto ; Pasini, Andrea ; Montini, Giovanni ; Murtas, Corrado ; Wang, Xiangyu ; Muruve, Daniel ; Vaglio, Augusto ; Martorana, Davide ; Pani, Antonello ; Scolari, Francesco ; Reiser, Jochen ; Ghiggeri, Gian M. / Rituximab is a safe and effective long-term treatment for children with steroid and calcineurin inhibitor-dependent idiopathic nephrotic syndrome. In: Kidney International. 2013 ; Vol. 84, No. 5. pp. 1025-1033.
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AU - Fornoni, Alessia

AU - Magnasco, Alberto

AU - Sica, Felice

AU - Bodria, Monica

AU - Caridi, Gianluca

AU - Wei, Changli

AU - Belingheri, Mirco

AU - Ghio, Luciana

AU - Merscher-gomez, Sandra M

AU - Edefonti, Alberto

AU - Pasini, Andrea

AU - Montini, Giovanni

AU - Murtas, Corrado

AU - Wang, Xiangyu

AU - Muruve, Daniel

AU - Vaglio, Augusto

AU - Martorana, Davide

AU - Pani, Antonello

AU - Scolari, Francesco

AU - Reiser, Jochen

AU - Ghiggeri, Gian M.

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