title: Rituximab treatment for relapsing minimal change disease and focal segmental glomerulosclerosis: a systematic review.
abstract: BACKGROUND
  Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) remain a therapeutic challenge, since steroids and other immunosuppressive agents exhibit an unfavorable adverse event spectrum. The aim of this review was to systematically summarize and analyze data from preexisting studies reporting the outcome of rituximab (RTX) treatment in these patients.
  
  
  METHODS
  Study data on adult patients with either steroid-dependent or frequently relapsing MCD/FSGS were identified by a PubMed and Embase search. The number of relapses was calculated and the use of immunosuppressive co-medication prior to and after RTX treatment was quantified.
  
  
  RESULTS
  We identified 14 studies including 86 patients with frequently relapsing and steroid-dependent MCD or FSGS. Treatment with RTX reduced the number of relapses per year from 1.3 (0-9) relapses prior to treatment compared to 0 (0-2) after therapy (p < 0.001). Proteinuria decreased from 2.43 (0-15) g/day to 0 (0-4.89) g/day (p < 0.001), while serum albumin increased from 2.9 (1.2-4.6) at baseline to 4.0 (1.8-5.09) g/l after RTX (p = 0.001). The use of immunosuppression used at the time of RTX administration was also reduced after RTX therapy (p < 0.001). Baseline serum albumin was lower (p = 0.018), whereas the number of immunosuppressants prior to RTX was higher (p = 0.018) in patients with relapse after RTX.
  
  
  CONCLUSIONS
  The published data suggest that RTX is effective in reducing the number of relapses and sparing immunosuppression in frequently relapsing and steroid-dependent nephrotic syndrome due to MCD and FSGS. These promising findings have to be confirmed in controlled and prospective studies.
authors.affiliation: Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kronbichler
authors.forename: Julia
authors.initials: J
authors.lastname: Kerschbaum
authors.forename: Gema
authors.initials: G
authors.lastname: Fernandez-Fresnedo
authors.forename: Elion
authors.initials: E
authors.lastname: Hoxha
authors.forename: Christine E
authors.initials: CE
authors.lastname: Kurschat
authors.forename: Martin
authors.initials: M
authors.lastname: Busch
authors.forename: Annette
authors.initials: A
authors.lastname: Bruchfeld
authors.forename: Gert
authors.initials: G
authors.lastname: Mayer
authors.forename: Michael
authors.initials: M
authors.lastname: Rudnicki
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy*; D006801:Humans; D009402:Nephrosis, Lipoid / Q000188:drug therapy*; D012008:Recurrence; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab