Efficacy and safety of rituximab treatment in children with primary glomerulonephritis.
BACKGROUND
The aim of our study was to analyze the efficacy and safety of rituximab, a chimeric monoclonal antibody against CD20 lymphocytes, as a nonstandard immunosuppressive therapy in children with different types of primary glomerulonephritis who were not eligible for routine treatment.


METHODS
The study group was composed of 16 children with proteinuric glomerulopathies, not responding to standard immunosuppressive therapy. The indications included steroid-resistant nephrotic syndrome (n=14) and steroid-dependent nephrotic syndrome (n=2). The dose of rituximab was established as 375 mg/m2 of body surface area, administered by intravenous infusion once weekly for 1 to 4 weeks, depending on the CD19 lymphocyte count. We evaluated proteinuria and plasma concentration of CD19 lymphocytes at intervals of 1, 3 and 6 months, after which patients received a single repeat dose.


RESULTS
Remission, defined as proteinuria less than 150 mg per 24 hours, was observed in 7 of the 16 children. There were no statistically significant differences in leukocyte counts between single and multiple rituximab doses. We also did not observe any clinical or biochemical side effects.


CONCLUSIONS
In conclusion, we postulate that alternative rituximab therapy should be taken into consideration in nephrotic patients not responding to standard therapy.
Department of Pediatric Nephrology, Poznan University of Medical Science, Poznan, Poland.
Jacek
J
Zachwieja
Magdalena
M
Silska
Danuta
D
Ostalska-Nowicka
Jolanta
J
Soltysiak
Katarzyna
K
Lipkowska
Andrzej
A
Blumczynski
Anna
A
Musielak
D000293:Adolescent; D000367:Age Factors; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018941:Antigens, CD19 / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002648:Child; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000187:drug effects / Q000276:immunology; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy; D011507:Proteinuria / Q000188:drug therapy; D012074:Remission Induction; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19; D015415:Biomarkers; D007166:Immunosuppressive Agents; D000069283:Rituximab