Rituximab as a front-line therapy for adult-onset minimal change disease with nephrotic syndrome.
Rituximab as a front-line therapy for adult-onset minimal change disease with nephrotic syndrome.
复制标题
DOI：
10.18632/oncotarget.25612
复制
发表时间：
2018-06-22
期刊：
影响因子：
--
通讯作者：
Roccatello D
中科院分区：
文献类型：
--
作者：
Fenoglio R;Sciascia S;Beltrame G;Mesiano P;Ferro M;Quattrocchio G;Menegatti E;Roccatello D
微小病变 (MCD) 占成人肾病综合征 (NS) 病例的 15%。成人 MCD 患者可能比儿童患者有更严重的临床特征。在儿童中，利妥昔单抗 (RTX) 自 2006 年以来一直用于治疗频繁复发的 NS。在成人中，有关 RTX 对 MCD 疗效的数据有限。我们报告了在成人活检证实的 MCD 中使用 RTX 的经验。我们的系列包括 6 名成年患者（2 名男性和 4 名女性），年龄 45-73 岁，接受 RTX 治疗（每周 4 次，剂量为 375 mg/m2）。 6 个月后，蛋白尿从 11,2 (23–4.8) g/24 小时下降至 0.6 (0–2) g/24 小时，并在随访时间较长的 4 名患者中下降至 0.4 (0–1, 4) g/24 小时。肌酐从 1.95 (0.5–5) mg/dl 降至 0.88 (0.6–1.3) mg/l。 5 名患者实现了肾脏完全缓解，其中 1 名患者的蛋白尿下降了 75%。 RTX 在至少 6 个月内成功消除了 100% 患者的 CD19 淋巴细胞。尚未观察到临床相关的不良事件。该病例系列显示了 RTX 在治疗 MCD 方面的显着疗效。 RTX 在 MCD 的复发形式和诱导治疗中都是一种有吸引力的替代方案。 RTX 可优先用于发生皮质类固醇不良反应的高风险患者，并应被视为复发性 NS 患者的替代选择。需要更多数据来告知临床实践如何在该患者群体中最好地使用 RTX，以便可以规划明确的随机试验。
Minimal change disease (MCD) accounts for 15% of adult nephrotic syndrome (NS) cases. Adult-MCD patients may have more severe clinical features than pediatric patients. In children, Rituximab (RTX) has been used since 2006 to treat frequently relapsing NS. In adults, data about the efficacy of RTX for MCD are limited. We report our experience on the use of RTX in adult biopsy-proven MCD. Our series includes 6 adult patients (2 males and 4 females), age 45–73 years, treated with RTX (4 weekly doses of 375 mg/m2). Proteinuria decreased from 11,2 (23–4.8) g/24 hours to 0.6 (0–2) g/24 hours after 6 months, and to 0.4 (0–1, 4) g/24 h in the 4 pts with the longer follow-up. Creatinine decreased from 1.95 (0.5–5) mg/dl to 0.88 (0.6–1.3) mg/l. Five patients achieved a complete renal remission, while in 1 pt proteinuria decreased by 75%. RTX successfully depleted CD19 lymphocytes in 100% of pts for at least 6 months. No clinically relevant adverse events have been observed. This case series shows a remarkable efficacy of RTX in treatment of MCD. RTX can be an attractive alternative both in recurrent forms and in induction-therapy of MCD. RTX may be preferentially used in patients at a high risk of development of the adverse effects of corticosteroids and should be considered as an alternative option in patients with recurrent NS. Additional data are needed to inform clinical practice on how best to use RTX in this patient population, so that definitive randomized trials can be planned.