title: Rituximab for minimal-change nephrotic syndrome in adulthood: predictive factors for response, long-term outcomes and tolerance.
abstract: BACKGROUND
  Minimal-change nephrotic syndrome (MCNS) is a common cause of steroid sensitive nephrotic syndrome (NS) with frequent relapse. Although steroids and calcineurin inhibitors (CNIs) are the cornerstone treatments, the use of rituximab (RTX), a monoclonal antibody targeting B cells, is an efficient and safe alternative in childhood.
  
  
  METHODS
  Because data from adults remain sparse, we conducted a large retrospective and multicentric study that included 41 adults with MCNS and receiving RTX.
  
  
  RESULTS
  Complete (NS remission and withdrawal of all immunosuppressants) and partial (NS remission and withdrawal of at least one immunosuppressants) clinical responses were obtained for 25 and 7 patients, respectively (overall response 78%), including 3 patients that only received RTX and had a complete clinical response. After a follow-up time of 39 months (6-71), relapses occurred in 18 responder patients [56%, median time 18 months (3-36)]. Seventeen of these received a second course of RTX and then had a complete (n = 13) or partial (n = 4) clinical response. From multivariate analysis, on-going mycophenolate mofetil (MMF) therapy at the time of RTX was the only predictive factor for RTX failure [HR = 0.07 95% CI (0.01-0.04), P = 0.003]. Interestingly, nine patients were still in remission at 14 months (3-36) after B-cell recovery. No significant early or late adverse event occurred after RTX therapy.
  
  
  CONCLUSIONS
  RTX is safe and effective in adult patients with MCNS and could be an alternative to steroids or CNIs in patients with a long history of relapsing MCNS.
authors.affiliation: Département de Néphrologie et Transplantation d'organes, CHU Rangueil, Toulouse, France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Guitard
authors.affiliation: Département de Néphrologie et Transplantation d'organes, CHU Rangueil, Toulouse, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Hebral
authors.affiliation: Service de Néphrologie et Transplantation rénale, CHU Hôtel-Dieu, Nantes, France.
authors.forename: Fadi
authors.initials: F
authors.lastname: Fakhouri
authors.affiliation: Service de Néphrologie, CHU Necker Enfants Malades, AP-HP, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Joly
authors.affiliation: Service de Néphrologie et Transplantation, CHU Bichat, AP-HP, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Daugas
authors.affiliation: Service de Néphrologie, CHU de Pontchaillou, Rennes, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rivalan
authors.affiliation: Service de Néphrologie Pédiatrique, CHU Dupuytren, Limoges, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Guigonis
authors.affiliation: Service de Néphrologie, Centre Hospitalier Annecy - Genevois, Annecy, France.
authors.forename: Françis
authors.initials: F
authors.lastname: Ducret
authors.affiliation: Service de Néphrologie, CHU Amiens-Picardie, Amiens, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Presne
authors.affiliation: Service de Néphrologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique.
authors.forename: Yves
authors.initials: Y
authors.lastname: Pirson
authors.affiliation: Service de Néphrologie et Transplantation rénale, CHU Hôtel-Dieu, Nantes, France.
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Hourmant
authors.affiliation: Service de Néphrologie, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Glachant
authors.affiliation: Service de Néphrologie, CHU Pellegrin, Bordeaux, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Vendrely
authors.affiliation: Service de Néphrologie et Transplantation rénale, CHU Pasteur, Nice, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Moranne
authors.affiliation: Département de Néphrologie et Transplantation d'organes, CHU Rangueil, Toulouse, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Faguer
authors.affiliation: Département de Néphrologie et Transplantation d'organes, CHU Rangueil, Toulouse, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Chauveau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D018951:Antigens, CD20; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004361:Drug Tolerance; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology*; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D007155:Immunologic Factors / Q000008:administration & dosage; D007223:Infant; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D005938:Glucocorticoids; D007155:Immunologic Factors; D000069283:Rituximab
keywords: B-cells; minimal-change disease; nephrotic syndrome; rituximab; steroids