title: Effect of single-dose rituximab on steroid-dependent minimal-change nephrotic syndrome in adults.
abstract: BACKGROUND
  Steroid-dependent minimal-change nephrotic syndrome (MCNS) requires administration of prolonged courses of prednisolone (PSL); therefore, a paradigm shift from such toxic 'non-specific' therapies to selective immunomodulating regimens is necessary for these cases.
  
  
  METHODS
  To assess the therapeutic effects of rituximab (an anti-CD20 antibody) in adult patients with steroid-dependent MCNS, we performed a prospective trial of the effects of a single dose of rituximab administered twice at an interval of 6 months in 25 MCNS patients. We evaluated the biochemical parameters and compared the clinical findings between the 12-month period before and 12-month period after the first rituximab infusion.
  
  
  RESULTS
  A significant reduction in the number of relapses and the total dose and the maintenance dose of PSL administered was observed during the 12-month period after the first rituximab infusion when compared with the findings during the 12-month period before the first rituximab infusion [25 (100%) versus 4 (16%), P < 0.001; 8.2 versus 3.3 g, P < 0.001; 26.4 mg/day at baseline versus 1.1 mg/day at 12-month, P < 0.0001]. Complete remission was achieved/maintained in all patients undergoing B-cell depletion. Four of 17 patients with B-cell repletion developed relapse.
  
  
  CONCLUSIONS
  Our results revealed that rituximab therapy was associated with a reduction in the number of relapses and in the total dose of PSL needed. Therefore, rituximab appears to be a useful therapeutic agent for adult patients with steroid-dependent MCNS. These results suggest that this treatment is rational and should be considered as an important option in the management of adult patients with steroid-dependent MCNS.
authors.affiliation: Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan. ttakei@kc.twmu.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Takei
authors.forename: Mitsuyo
authors.initials: M
authors.lastname: Itabashi
authors.forename: Takahito
authors.initials: T
authors.lastname: Moriyama
authors.forename: Chiari
authors.initials: C
authors.lastname: Kojima
authors.forename: Syunji
authors.initials: S
authors.lastname: Shiohira
authors.forename: Ari
authors.initials: A
authors.lastname: Shimizu
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tsuruta
authors.forename: Ayami
authors.initials: A
authors.lastname: Ochi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Amemiya
authors.forename: Toshio
authors.initials: T
authors.lastname: Mochizuki
authors.forename: Keiko
authors.initials: K
authors.lastname: Uchida
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D009402:Nephrosis, Lipoid / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab; D011239:Prednisolone