Efficacy of Rituximab for Minimal Change Disease and Focal Segmental Glomerulosclerosis with Frequently Relapsing or Steroid-Dependent Nephrotic Syndrome in Adults: A Chinese Multicenter Retrospective Study

Introduction Rituximab has been proven effective and safe in pediatric patients with frequently relapsing or steroid-dependent nephrotic syndrome (FR/SDNS). We aimed to analyze the efficacy and safety of rituximab in adult FR/SDNS patients with minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). Methods A retrospective cohort study at three nephrology centers in China included adult FR/SDNS patients with biopsy-proven MCD or FSGS. Primary outcomes were relapse frequency and first relapse-free survival time. Adverse events were well recorded and logistic regression analyses were used to investigate risk factors of relapse. Results Eighty-one patients (age 25.0 years, interquartile range, 20.0-40.5; 67% males; 82.7% MCD) received an average rituximab dose of 1393.8 +/- 618.7 mg/2y during the two-year follow-up period. The relapse frequency, calculated as the ratio of relapse times to follow-up years, significantly decreased after rituximab treatment [0.04 (0.00, 0.08) vs. 1.71 (1.00, 2.45), P < 0.001]. The first relapse-free survival time was 16.7 +/- 8.0 months. Fifty-seven patients (70.4%) achieved cessation of corticosteroids and immunosuppressants within three months after the first rituximab infusion. Adverse events were mostly mild, and no severe treatment-related adverse events were observed. Low serum albumin level before rituximab and high CD56(+)CD16(+) natural killer cell count after rituximab were independent risk factors of relapse within two years after rituximab treatment. Conclusion Rituximab was proven an effective and safe treatment option for adult FR/SDNS patients with MCD or FSGS in maintaining disease remission and minimizing corticosteroid exposure.