Clinical practice guidelines for rituximab treatment in children with steroid-sensitive nephrotic syndrome.

Abstract

Background: Steroid-sensitive nephrotic syndrome is a prevalent glomerular disease in children. The 2021 guidelines for glomerular disease management by Kidney Disease: Improving Global Outcomes and the 2023 recommendations for steroid-sensitive nephrotic syndrome management by International Pediatric Nephrology Association recommend rituximab for frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome in children. However, there is considerable variation in rituximab application, including administration timing, dose, frequency, concomitant medications, and follow-up schedules. In addition, rituximab use for nephrotic syndrome remains off-label in most countries.

Data sources: The "Pediatric Nephrology Committee of the Chinese Medical Doctor Association", the "Pediatric Nephrology Society of the Chinese Medical Association", and the "Fudan University GRADE Center" collaborated to develop a clinical practice guideline for rituximab in pediatric steroid-sensitive nephrotic syndrome. Databases and starting/ending time for retrieval were as follows. Databases in English: PubMed, Embase, Cochrane, and Scopus; database in Chinese: Chinese Biomedical Literature Service provided by SinoMed. The publication dates were limited to those from 2004 to June 26, 2022.

Results: Through systematic reviews and meta-analyses covering nine clinically relevant patient or population covered, intervention, comparator, and outcome questions, seven recommendations were formulated and formally graded according to these guidelines.

Conclusions: This guideline aspires to serve as a pivotal resource for healthcare providers, offering guidance on administration timing, dosage, frequency, concomitant medications, and follow-up protocols.