Rituximab in primary podocytopathies: efficacy and safety in a retrospective cohort.

IF 1.3 Q3 UROLOGY & NEPHROLOGY
Gabriel Teixeira Montezuma Sales, Danilo Euclides Fernandes, Gianna Mastroianni Kirsztajn
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引用次数: 0

Abstract

Introduction: Podocytopathies are an important cause of nephrotic syndrome, and immunosuppression plays a pivotal role in disease management. The efficacy of biological agents such as rituximab (RTX), however, remains unclear, especially in adults. This study hypothesized that RTX is efficient and safe in the treatment of steroid-sensitive and steroid-resistant primary podocytopathies.

Method: A retrospective cohort study was conducted based on medical records before the first infusion of RTX (T0) and 1 to 3 months (T1) and 3 to 6 months after infusion (T2). Patients had biopsy-proven podocytopathies and received at least 500 mg of RTX. Individuals with secondary glomerular diseases were excluded.

Results: A total of 31 patients with a mean age at infusion of 32.9 years (SD 11.0) were included. At T2, remission was reached in 45.2%, with complete remission in 19.4%. Prior response to steroids was related to a better prognosis, with remission in up to 68.5% of these patients. Moreover, 20.0% of steroid-resistant patients reached adapted remission (≥ 35% proteinuria decrease + ≥ 20% serum albumin increase). Hypertension and previous use of calcineurin inhibitors were not predictors of clinical response. The most frequent adverse events were infection (12.9%) and rash (9.7%).

Discussion: In conclusion, our results suggest that RTX is a useful therapeutic option not only for steroid-sensitive podocytopathies, but also in selected steroid-resistant cases, determining a proteinuria decrease that can contribute positively to the clinical management of such glomerular diseases. RTX was generally efficient and well tolerated in this adult cohort.

利妥昔单抗治疗原发性足细胞病变:回顾性队列的有效性和安全性。
足细胞病变是肾病综合征的重要病因,免疫抑制在疾病治疗中起着关键作用。然而,生物制剂如利妥昔单抗(RTX)的疗效仍不清楚,特别是在成人中。本研究假设RTX在治疗激素敏感和激素抵抗的原发性足细胞病中是有效和安全的。方法:根据首次输注RTX前(T0)、输注后1 ~ 3个月(T1)和3 ~ 6个月(T2)的病历资料进行回顾性队列研究。患者有活组织检查证实的足细胞病变,并接受至少500毫克RTX。排除继发性肾小球疾病患者。结果:共纳入31例患者,平均输注年龄为32.9岁(SD 11.0)。T2时,45.2%的患者缓解,19.4%的患者完全缓解。先前对类固醇的反应与更好的预后有关,这些患者的缓解率高达68.5%。此外,20.0%的类固醇抵抗患者达到适应性缓解(蛋白尿减少≥35% +血清白蛋白增加≥20%)。高血压和既往使用钙调磷酸酶抑制剂不是临床反应的预测因素。最常见的不良事件是感染(12.9%)和皮疹(9.7%)。讨论:总之,我们的研究结果表明,RTX不仅是类固醇敏感足细胞病的有效治疗选择,而且在选定的类固醇耐药病例中,确定蛋白尿减少可以对此类肾小球疾病的临床管理做出积极贡献。RTX在该成人队列中普遍有效且耐受性良好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.20
自引率
16.70%
发文量
208
审稿时长
16 weeks
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