Long-Term Efficacy and Safety of Repeated Rituximab to Maintain Remission in Idiopathic Childhood Nephrotic Syndrome: An International Study.

Agammaglobulinemia / chemically induced Child Female Humans Immunosuppressive Agents / therapeutic use Male Nephrosis, Lipoid / drug therapy Nephrotic Syndrome / drug therapy Neutropenia / chemically induced Recurrence Retrospective Studies Rituximab / adverse effects Steroids / therapeutic use Treatment Outcome
biologics children hypogammaglobulinemia nephrotic syndrome neutropenia rituximab

Journal

Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836

Informations de publication

Date de publication:
06 2022
Historique:
received: 15 11 2021
accepted: 14 03 2022
pubmed: 1 4 2022
medline: 3 6 2022
entrez: 31 3 2022
Statut: ppublish

Résumé

Long-term outcomes after multiple courses of rituximab among children with frequently relapsing, steroid-dependent nephrotic syndrome (FRSDNS) are unknown. A retrospective cohort study at 16 pediatric nephrology centers from ten countries in Asia, Europe, and North America included children with FRSDNS who received two or more courses of rituximab. Primary outcomes were relapse-free survival and adverse events. A total of 346 children (age, 9.8 years; IQR, 6.6-13.5 years; 73% boys) received 1149 courses of rituximab. A total of 145, 83, 50, 28, 22, and 18 children received two, three, four, five, six, and seven or more courses, respectively. Median (IQR) follow-up was 5.9 (4.3-7.7) years. Relapse-free survival differed by treatment courses (clustered log-rank test Children receiving repeated courses of rituximab for FRSDNS experience an improving clinical response. Side effects appear acceptable, but significant complications can occur. These findings support repeated rituximab use in FRSDNS.

Sections du résumé

BACKGROUND
Long-term outcomes after multiple courses of rituximab among children with frequently relapsing, steroid-dependent nephrotic syndrome (FRSDNS) are unknown.
METHODS
A retrospective cohort study at 16 pediatric nephrology centers from ten countries in Asia, Europe, and North America included children with FRSDNS who received two or more courses of rituximab. Primary outcomes were relapse-free survival and adverse events.
RESULTS
A total of 346 children (age, 9.8 years; IQR, 6.6-13.5 years; 73% boys) received 1149 courses of rituximab. A total of 145, 83, 50, 28, 22, and 18 children received two, three, four, five, six, and seven or more courses, respectively. Median (IQR) follow-up was 5.9 (4.3-7.7) years. Relapse-free survival differed by treatment courses (clustered log-rank test
CONCLUSIONS
Children receiving repeated courses of rituximab for FRSDNS experience an improving clinical response. Side effects appear acceptable, but significant complications can occur. These findings support repeated rituximab use in FRSDNS.

Identifiants

DOI: 10.1681/ASN.2021111472 PMID: 35354600 PMC: PMC9161790
pubmed: 35354600
pii: 00001751-202206000-00017
doi: 10.1681/ASN.2021111472
pmc: PMC9161790
doi:

Substances chimiques

Immunosuppressive Agents 0
Steroids 0
Rituximab 4F4X42SYQ6

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1193-1207

Informations de copyright

Copyright © 2022 by the American Society of Nephrology.

Références

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Auteurs

Eugene Yu-Hin Chan (EY)

Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong SAR.
Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR.
Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, National Health Service Trust, London, United Kingdom.
ORCID: 0000-0002-1463-6005

Ellen L M Yu (ELM)

Clinical Research Center, Princess Margaret Hospital, Hong Kong SAR.
ORCID: 0000-0001-5768-2100

Andrea Angeletti (A)

Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genova, Italy.
ORCID: 0000-0002-6121-5326

Zainab Arslan (Z)

Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, National Health Service Trust, London, United Kingdom.

Biswanath Basu (B)

Division of Pediatric Nephrology, Nilratan Sircar Medical College and Hospital, Kolkata, India.

Olivia Boyer (O)

Pediatric Nephrology, Reference Center for Nephrotic Syndrome in Children and Adults, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Université Paris Cité, Paris, France.

Chang-Yien Chan (CY)

Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore.
ORCID: 0000-0001-5841-1417

Manuela Colucci (M)

Renal Diseases Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Guillaume Dorval (G)

Pediatric Nephrology, Reference Center for Nephrotic Syndrome in Children and Adults, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Université Paris Cité, Paris, France.
ORCID: 0000-0003-3883-1398

Claire Dossier (C)

Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France.

Stefania Drovandi (S)

Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.

Gian Marco Ghiggeri (GM)

Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
ORCID: 0000-0003-3659-9062

Debbie S Gipson (DS)

Division of Nephrology, Department of Pediatrics, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan.
ORCID: 0000-0003-4473-9045

Riku Hamada (R)

Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
ORCID: 0000-0002-7151-459

Julien Hogan (J)

Department of Pediatric Nephrology, Robert-Debré Hospital, Reference Center for Nephrotic Syndrome in Children and Adults, Centre de Référence Syndrome Néphrotique de l'Enfant et de l'Adulte (CMR SNI), AP-HP, Université Paris Cité, Paris, France.

Kenji Ishikura (K)

Department of Pediatrics, Kitasato University School of Medicine, Tokyo, Japan.
Department of Pediatrics, Kitasato University Hospital, Tokyo, Japan.

Koichi Kamei (K)

Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.

Markus J Kemper (MJ)

Department of Pediatrics, Asklepios Medical School, Hamburg, Germany.

Alison Lap-Tak Ma (AL)

Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong SAR.
Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR.

Rulan S Parekh (RS)

Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada.

Seetha Radhakrishnan (S)

Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada.

Priya Saini (P)

Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada.

Qian Shen (Q)

Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.

Rajiv Sinha (R)

Pediatric Nephrology Unit, Institute of Child Health, Kolkata, India.

Chantida Subun (C)

Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, National Health Service Trust, London, United Kingdom.

Sharon Teo (S)

Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore.

Marina Vivarelli (M)

Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Hazel Webb (H)

Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, National Health Service Trust, London, United Kingdom.

Hong Xu (H)

Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.

Hui Kim Yap (HK)

Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore.

Kjell Tullus (K)

Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, National Health Service Trust, London, United Kingdom.

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Classifications MeSH

questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Agammaglobulinémie › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Effets physiologiques des médicaments › Facteurs immunologiques › Immunosuppresseurs › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Maladies du rein › Néphrose › Néphrose lipoïdique › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Maladies du rein › Néphrose › Syndrome néphrotique › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Hémopathies et maladies lymphatiques › Hémopathies › Troubles leucocytaires › Leucopénie › Agranulocytose › Neutropénie › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Récidive › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Globulines › Sérum-globulines › Immunoglobulines › Anticorps › Anticorps monoclonaux › Anticorps monoclonaux d'origine murine › Rituximab › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Composés polycycliques › Composés à cycles fusionnés › Stéroïdes › Long-Term Efficacy and Safety of Repeated...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Long-Term Efficacy and Safety of Repeated...