The Evolving Role of Rituximab in Adult Minimal Change Glomerulopathy.
BACKGROUND
Minimal-change glomerulopathy is defined histologically by the presence of normal glomeruli on light microscopy and diffuse podocyte effacement on electron microscopy. Although effective in children, corticosteroid treatment in adults is more variable and time to response can be prolonged. Data to support rituximab use in adults with corticosteroid-dependent or resistant minimal-change glomerulopathy are limited. Here, we describe the clinical course of adults with corticosteroid-dependent or -resistant minimal-change glomerulopathy who received rituximab.


METHODS
Demographic and clinical data were collected and analyzed from all adult patients with native kidney, biopsy-proven, minimal-change glomerulopathy who were administered rituximab between 2009 and 2014 and cared for at the UNC Kidney Center.


RESULTS
Ten patients with corticosteroid-resistant (n = 5) or corticosteroid-dependent (n = 5) idiopathic minimal-change glomerulopathy were treated with rituximab between 2009 and 2014. Rituximab treatment induced remission in all 10 patients with a median time to remission of 2 months. The median time from rituximab to corticosteroid discontinuation was 3.5 months. The median remission time was 29 months and follow-up time was 39.5 months. No serious adverse events attributable to rituximab were observed.


CONCLUSIONS
Rituximab induced remission in all patients with corticosteroid-dependent or -resistant minimal-change glomerulopathy, and may hold great therapeutic potential with good efficacy and minimal toxicity. Mounting evidence implies that a well-conducted randomized controlled clinical trial using rituximab in adults with minimal-change glomerulopathy in both corticosteroid-resistant and corticosteroid-dependent patients is warranted.
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Landon C
LC
Brown
Meghan A
MA
Jobson
Fernanda
F
Payan Schober
Emily H
EH
Chang
Ronald J
RJ
Falk
Patrick H
PH
Nachman
William F
WF
Pendergraft
D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000276:immunology; D001706:Biopsy; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D028761:Withholding Treatment; D055815:Young Adult
D018951:Antigens, CD20; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000069283:Rituximab