Extended infusion of rituximab combined with steroids is effective in inducing remission and reducing relapse in adult minimal change disease.
Extended infusion of rituximab combined with steroids is effective in inducing remission and reducing relapse in adult minimal change disease.
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延长输注利妥昔单抗联合类固醇可有效诱导成人微小病变病的缓解和减少复发
DOI：
10.1186/s12882-021-02437-4
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发表时间：
2021-07-01
期刊：
影响因子：
2.3
通讯作者：
Ai J
中科院分区：
文献类型：
--
作者：
Liu D;Zhou Z;Wang M;Nie S;Li J;Hu B;He W;Wang G;Ai J
背景微小病变是成人肾病综合征的常见病因。由于长期暴露，较高的复发率使患者面临类固醇毒性的风险。利妥昔单抗被认为可以维持较长时间的缓解，并且可以停用类固醇和其他免疫抑制剂，不良事件较少。然而，最佳剂量和给药间隔尚未探索。Methods 25例患者从2017-10至2020-03在中国南方医院入组。从病历和实验室数据库中提取临床和生物学数据。利妥昔单抗375 mg/m2，3次/周，联合糖皮质激素治疗。完全缓解定义为尿蛋白减少至0.3g/d。记录平均14.71个月的缓解率、复发率、利妥昔单抗治疗前后使用的类固醇以及不良反应。结果22例患者平均3.26个月达到完全缓解，随访期间仅3例患者分别复发一次。平均缓解维持时间为11.6个月，停药后为5个月。末次随访时类固醇剂量为6.09 mg/d，与利妥昔单抗治疗前的28.15 mg/d相比显著减少。利妥昔单抗治疗前后的复发率分别为1.43和0.1。只有四个轻微的不良事件recorded.ConclusionsTherapy包括375 mg/m2利妥昔单抗3次3周1次联合糖皮质激素是有效的诱导缓解成人微小病变疾病。复发率和使用的类固醇剂量都显着降低，副作用少。
BackgroundMinimal change disease is a common cause of nephrotic syndrome in adults. Higher relapse rate put patients at risk of steroids toxicity due to long-term exposure. Rituximab has been suggested to maintain long time remission and withdraw steroids and other immunosuppressants with fewer adverse events. However, optimal dose and dosing interval have not been explored.MethodsTwenty-five patients were enrolled from 2017-10 to 2020-03 in Nanfang Hospital in China. Clinical and biological data were extracted from medical records and laboratory databases. Therapy composed of 375mg/m2rituximab once three weeks for 3 dose and corticosteroid was applied. Complete remission was defined as reduction of proteinuria to 0.3g/d. Remission rate, relapse rate, steroids used before and after rituximab therapy and adverse effects were documented at a mean time of 14.71 months.ResultsTwenty-two patients achieved complete remission for an average of 3.26 months and only 3 patients experienced one relapse respectively during the follow-up period. The mean remission maintenance time was 11.6 months, and was 5 months after steroids withdrawal. Steroids dose at last follow-up was 6.09mg/d, which was significantly reduced compared to 28.15mg/d before rituximab. Relapse rate before and after rituximab was 1.43 and 0.1, respectively. Only four minor adverse events were recorded.ConclusionsTherapy consisted of 375mg/m2rituximab once three weeks for 3 dose combined with corticosteroid is effective in inducing remission in adult patients with minimal change disease. Both of the relapse rate and dose of steroids used are significantly decreased with fewer side effects.
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影响因子：
--
作者：
Fenoglio R;Sciascia S;Beltrame G;Mesiano P;Ferro M;Quattrocchio G;Menegatti E;Roccatello D
通讯作者：
Roccatello D
影响因子：
4.6
作者：
King C;Logan S;Smith SW;Hewins P
通讯作者：
Hewins P
影响因子：
6.1
作者：
Bruchfeld, Annette;Benedek, Samiha;Korkeila, Maarit
通讯作者：
Korkeila, Maarit
影响因子：
13.6
作者：
Mallipattu, Sandeep K.;Guo, Yiqing;He, John C.
通讯作者：
He, John C.
影响因子：
4.6
作者：
Cortazar, Frank B.;Rosenthal, Jillian;Niles, John L.
通讯作者：
Niles, John L.