Rituximab in treatment of collapsing FSGS—A case series
Background Collapsing focal segmental glomerulosclerosis (cFSGS) is an aggressive glomerular disease presenting as a nephrotic syndrome that has lower rates of remission with conventional immunosuppressive therapy and rapidly progresses to end‐stage‐renal‐disease (ESRD). We report eight cases of HIV...
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| Veröffentlicht in: | Nephrology (Carlton, Vic.) Vic.), 2021-02, Vol.26 (2), p.134-141 |
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| creator | Girimaji, Niveditha Bharati, Joyita Nada, Ritambhra Rathi, Manish Kohli, Harbir Singh Ramachandran, Raja |
| description | Background
Collapsing focal segmental glomerulosclerosis (cFSGS) is an aggressive glomerular disease presenting as a nephrotic syndrome that has lower rates of remission with conventional immunosuppressive therapy and rapidly progresses to end‐stage‐renal‐disease (ESRD). We report eight cases of HIV‐negative cFSGS treated with rituximab.
Methods
The current report is a retrospective case series of cFSGS treated with rituximab from January 2011 to March 2020, at varying phases of the disease.
Results
Eight out of the 70 cFSGS patients received rituximab. The median age of patients was 30 years (IQR 24.25‐37.5); five patients were males. The median serum creatinine, mean serum albumin and median 24 hours urinary protein at presentation was 0.9 (IQR 0.66‐1.27) mg/dL, 2.95 ± 1.15 g/dL, 4.87 (IQR 1.64‐5.75) g/day, respectively. Two patients were steroid‐resistant, one steroid and tacrolimus dependent, one steroid and cyclosporine dependent, two steroids and tacrolimus resistant, one steroid, tacrolimus, cyclophosphamide, mycophenolate mofetil resistant and one steroid‐resistant and tacrolimus dependent before rituximab therapy. Rituximab was given either as targeted therapy (after an initial dose of 375 mg/m2; patients having CD‐19 levels >5/μL or >1% at 1 month received additional low‐dose [100 mg] of rituximab), or weekly regimen. Five patients received CD‐19 targeted rituximab; three received weekly doses of 375 mg/m2, cumulative doses being 820 ± 228.03 mg, and 1800 ± 721.11 mg, respectively. At the end of median follow‐up of 15 months, five (62.5%) patients were in remission (three partial, two complete remissions), two (25%) were resistant to therapy; one (12.5%) progressed to ESRD.
Conclusion
Rituximab is reasonably safe and achieves/maintains remission in 60% of cFSGS cases.
SUMMARY AT A GLANCE
This is a retrospective study reporting the effects of Rituximab on 8 patients with the collapsing form of focal segmental glomerulosclerosis. Whilst retrospective in nature, the study suggested that rituximab might be a promising form of treatment for this condition, which is traditionally resistant to immunosuppression therapy, resulting in a remission rate of 60% with a reasonable safety profile. |
| doi_str_mv | 10.1111/nep.13757 |
| format | Article |
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Collapsing focal segmental glomerulosclerosis (cFSGS) is an aggressive glomerular disease presenting as a nephrotic syndrome that has lower rates of remission with conventional immunosuppressive therapy and rapidly progresses to end‐stage‐renal‐disease (ESRD). We report eight cases of HIV‐negative cFSGS treated with rituximab.
Methods
The current report is a retrospective case series of cFSGS treated with rituximab from January 2011 to March 2020, at varying phases of the disease.
Results
Eight out of the 70 cFSGS patients received rituximab. The median age of patients was 30 years (IQR 24.25‐37.5); five patients were males. The median serum creatinine, mean serum albumin and median 24 hours urinary protein at presentation was 0.9 (IQR 0.66‐1.27) mg/dL, 2.95 ± 1.15 g/dL, 4.87 (IQR 1.64‐5.75) g/day, respectively. Two patients were steroid‐resistant, one steroid and tacrolimus dependent, one steroid and cyclosporine dependent, two steroids and tacrolimus resistant, one steroid, tacrolimus, cyclophosphamide, mycophenolate mofetil resistant and one steroid‐resistant and tacrolimus dependent before rituximab therapy. Rituximab was given either as targeted therapy (after an initial dose of 375 mg/m2; patients having CD‐19 levels >5/μL or >1% at 1 month received additional low‐dose [100 mg] of rituximab), or weekly regimen. Five patients received CD‐19 targeted rituximab; three received weekly doses of 375 mg/m2, cumulative doses being 820 ± 228.03 mg, and 1800 ± 721.11 mg, respectively. At the end of median follow‐up of 15 months, five (62.5%) patients were in remission (three partial, two complete remissions), two (25%) were resistant to therapy; one (12.5%) progressed to ESRD.
Conclusion
Rituximab is reasonably safe and achieves/maintains remission in 60% of cFSGS cases.
SUMMARY AT A GLANCE
This is a retrospective study reporting the effects of Rituximab on 8 patients with the collapsing form of focal segmental glomerulosclerosis. Whilst retrospective in nature, the study suggested that rituximab might be a promising form of treatment for this condition, which is traditionally resistant to immunosuppression therapy, resulting in a remission rate of 60% with a reasonable safety profile.</description><identifier>ISSN: 1320-5358</identifier><identifier>EISSN: 1440-1797</identifier><identifier>DOI: 10.1111/nep.13757</identifier><identifier>PMID: 32662534</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>collapsing focal segmental glomerulosclerosis ; Creatinine ; Cyclophosphamide ; Cyclosporins ; HIV ; Human immunodeficiency virus ; Immunosuppressive agents ; Immunotherapy ; Kidney diseases ; Monoclonal antibodies ; Mycophenolate mofetil ; Mycophenolic acid ; Nephrotic syndrome ; Remission ; Rituximab ; steroid dependent nephrotic syndrome ; Steroid hormones ; steroid resistant nephrotic syndrome ; Tacrolimus</subject><ispartof>Nephrology (Carlton, Vic.), 2021-02, Vol.26 (2), p.134-141</ispartof><rights>2020 Asian Pacific Society of Nephrology</rights><rights>2020 Asian Pacific Society of Nephrology.</rights><rights>2021 Asian Pacific Society of Nephrology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2687-d23d1870e020b22863b2ac51d5167ea3394e07138173f2e198bc1bb1d11e37593</citedby><cites>FETCH-LOGICAL-c2687-d23d1870e020b22863b2ac51d5167ea3394e07138173f2e198bc1bb1d11e37593</cites><orcidid>0000-0002-1273-9107 ; 0000-0003-4806-2297</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fnep.13757$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fnep.13757$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32662534$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Girimaji, Niveditha</creatorcontrib><creatorcontrib>Bharati, Joyita</creatorcontrib><creatorcontrib>Nada, Ritambhra</creatorcontrib><creatorcontrib>Rathi, Manish</creatorcontrib><creatorcontrib>Kohli, Harbir Singh</creatorcontrib><creatorcontrib>Ramachandran, Raja</creatorcontrib><title>Rituximab in treatment of collapsing FSGS—A case series</title><title>Nephrology (Carlton, Vic.)</title><addtitle>Nephrology (Carlton)</addtitle><description>Background
Collapsing focal segmental glomerulosclerosis (cFSGS) is an aggressive glomerular disease presenting as a nephrotic syndrome that has lower rates of remission with conventional immunosuppressive therapy and rapidly progresses to end‐stage‐renal‐disease (ESRD). We report eight cases of HIV‐negative cFSGS treated with rituximab.
Methods
The current report is a retrospective case series of cFSGS treated with rituximab from January 2011 to March 2020, at varying phases of the disease.
Results
Eight out of the 70 cFSGS patients received rituximab. The median age of patients was 30 years (IQR 24.25‐37.5); five patients were males. The median serum creatinine, mean serum albumin and median 24 hours urinary protein at presentation was 0.9 (IQR 0.66‐1.27) mg/dL, 2.95 ± 1.15 g/dL, 4.87 (IQR 1.64‐5.75) g/day, respectively. Two patients were steroid‐resistant, one steroid and tacrolimus dependent, one steroid and cyclosporine dependent, two steroids and tacrolimus resistant, one steroid, tacrolimus, cyclophosphamide, mycophenolate mofetil resistant and one steroid‐resistant and tacrolimus dependent before rituximab therapy. Rituximab was given either as targeted therapy (after an initial dose of 375 mg/m2; patients having CD‐19 levels >5/μL or >1% at 1 month received additional low‐dose [100 mg] of rituximab), or weekly regimen. Five patients received CD‐19 targeted rituximab; three received weekly doses of 375 mg/m2, cumulative doses being 820 ± 228.03 mg, and 1800 ± 721.11 mg, respectively. At the end of median follow‐up of 15 months, five (62.5%) patients were in remission (three partial, two complete remissions), two (25%) were resistant to therapy; one (12.5%) progressed to ESRD.
Conclusion
Rituximab is reasonably safe and achieves/maintains remission in 60% of cFSGS cases.
SUMMARY AT A GLANCE
This is a retrospective study reporting the effects of Rituximab on 8 patients with the collapsing form of focal segmental glomerulosclerosis. Whilst retrospective in nature, the study suggested that rituximab might be a promising form of treatment for this condition, which is traditionally resistant to immunosuppression therapy, resulting in a remission rate of 60% with a reasonable safety profile.</description><subject>collapsing focal segmental glomerulosclerosis</subject><subject>Creatinine</subject><subject>Cyclophosphamide</subject><subject>Cyclosporins</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Immunosuppressive agents</subject><subject>Immunotherapy</subject><subject>Kidney diseases</subject><subject>Monoclonal antibodies</subject><subject>Mycophenolate mofetil</subject><subject>Mycophenolic acid</subject><subject>Nephrotic syndrome</subject><subject>Remission</subject><subject>Rituximab</subject><subject>steroid dependent nephrotic syndrome</subject><subject>Steroid hormones</subject><subject>steroid resistant nephrotic syndrome</subject><subject>Tacrolimus</subject><issn>1320-5358</issn><issn>1440-1797</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kMtOwzAQRS0EoqWw4AdQJDawSOux49hZVlVbkCpAFNZWHhOUKi_iRNAdH8EX8iUYUlggMZuZxdHVnUPIKdAx2JmUWI-BSyH3yBA8j7ogA7lvb86oK7hQA3JkzIZSkMyHQzLgzPeZ4N6QBPdZ271mRRg5Wem0DYZtgWXrVKkTV3ke1iYrn5zFern-eHufOnFo0DHYZGiOyUEa5gZPdntEHhfzh9mVu7pdXs-mKzdmvpJuwngCSlKkjEaMKZ9HLIwFJAJ8iSHngYdUAlcgecoQAhXFEEWQAKB9KeAjctHn1k313KFpdZGZGG23EqvOaOYxrqj9VFj0_A-6qbqmtO0spainBOXSUpc9FTeVMQ2mum6sgGargeovn9r61N8-LXu2S-yiApNf8kegBSY98JLluP0_Sd_M7_rITwVKfFI</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Girimaji, Niveditha</creator><creator>Bharati, Joyita</creator><creator>Nada, Ritambhra</creator><creator>Rathi, Manish</creator><creator>Kohli, Harbir Singh</creator><creator>Ramachandran, Raja</creator><general>John Wiley & Sons Australia, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1273-9107</orcidid><orcidid>https://orcid.org/0000-0003-4806-2297</orcidid></search><sort><creationdate>202102</creationdate><title>Rituximab in treatment of collapsing FSGS—A case series</title><author>Girimaji, Niveditha ; Bharati, Joyita ; Nada, Ritambhra ; Rathi, Manish ; Kohli, Harbir Singh ; Ramachandran, Raja</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2687-d23d1870e020b22863b2ac51d5167ea3394e07138173f2e198bc1bb1d11e37593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>collapsing focal segmental glomerulosclerosis</topic><topic>Creatinine</topic><topic>Cyclophosphamide</topic><topic>Cyclosporins</topic><topic>HIV</topic><topic>Human immunodeficiency virus</topic><topic>Immunosuppressive agents</topic><topic>Immunotherapy</topic><topic>Kidney diseases</topic><topic>Monoclonal antibodies</topic><topic>Mycophenolate mofetil</topic><topic>Mycophenolic acid</topic><topic>Nephrotic syndrome</topic><topic>Remission</topic><topic>Rituximab</topic><topic>steroid dependent nephrotic syndrome</topic><topic>Steroid hormones</topic><topic>steroid resistant nephrotic syndrome</topic><topic>Tacrolimus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Girimaji, Niveditha</creatorcontrib><creatorcontrib>Bharati, Joyita</creatorcontrib><creatorcontrib>Nada, Ritambhra</creatorcontrib><creatorcontrib>Rathi, Manish</creatorcontrib><creatorcontrib>Kohli, Harbir Singh</creatorcontrib><creatorcontrib>Ramachandran, Raja</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology (Carlton, Vic.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Girimaji, Niveditha</au><au>Bharati, Joyita</au><au>Nada, Ritambhra</au><au>Rathi, Manish</au><au>Kohli, Harbir Singh</au><au>Ramachandran, Raja</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rituximab in treatment of collapsing FSGS—A case series</atitle><jtitle>Nephrology (Carlton, Vic.)</jtitle><addtitle>Nephrology (Carlton)</addtitle><date>2021-02</date><risdate>2021</risdate><volume>26</volume><issue>2</issue><spage>134</spage><epage>141</epage><pages>134-141</pages><issn>1320-5358</issn><eissn>1440-1797</eissn><abstract>Background
Collapsing focal segmental glomerulosclerosis (cFSGS) is an aggressive glomerular disease presenting as a nephrotic syndrome that has lower rates of remission with conventional immunosuppressive therapy and rapidly progresses to end‐stage‐renal‐disease (ESRD). We report eight cases of HIV‐negative cFSGS treated with rituximab.
Methods
The current report is a retrospective case series of cFSGS treated with rituximab from January 2011 to March 2020, at varying phases of the disease.
Results
Eight out of the 70 cFSGS patients received rituximab. The median age of patients was 30 years (IQR 24.25‐37.5); five patients were males. The median serum creatinine, mean serum albumin and median 24 hours urinary protein at presentation was 0.9 (IQR 0.66‐1.27) mg/dL, 2.95 ± 1.15 g/dL, 4.87 (IQR 1.64‐5.75) g/day, respectively. Two patients were steroid‐resistant, one steroid and tacrolimus dependent, one steroid and cyclosporine dependent, two steroids and tacrolimus resistant, one steroid, tacrolimus, cyclophosphamide, mycophenolate mofetil resistant and one steroid‐resistant and tacrolimus dependent before rituximab therapy. Rituximab was given either as targeted therapy (after an initial dose of 375 mg/m2; patients having CD‐19 levels >5/μL or >1% at 1 month received additional low‐dose [100 mg] of rituximab), or weekly regimen. Five patients received CD‐19 targeted rituximab; three received weekly doses of 375 mg/m2, cumulative doses being 820 ± 228.03 mg, and 1800 ± 721.11 mg, respectively. At the end of median follow‐up of 15 months, five (62.5%) patients were in remission (three partial, two complete remissions), two (25%) were resistant to therapy; one (12.5%) progressed to ESRD.
Conclusion
Rituximab is reasonably safe and achieves/maintains remission in 60% of cFSGS cases.
SUMMARY AT A GLANCE
This is a retrospective study reporting the effects of Rituximab on 8 patients with the collapsing form of focal segmental glomerulosclerosis. Whilst retrospective in nature, the study suggested that rituximab might be a promising form of treatment for this condition, which is traditionally resistant to immunosuppression therapy, resulting in a remission rate of 60% with a reasonable safety profile.</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>32662534</pmid><doi>10.1111/nep.13757</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-1273-9107</orcidid><orcidid>https://orcid.org/0000-0003-4806-2297</orcidid></addata></record> |
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| source | Wiley Journals |
| subjects | collapsing focal segmental glomerulosclerosis Creatinine Cyclophosphamide Cyclosporins HIV Human immunodeficiency virus Immunosuppressive agents Immunotherapy Kidney diseases Monoclonal antibodies Mycophenolate mofetil Mycophenolic acid Nephrotic syndrome Remission Rituximab steroid dependent nephrotic syndrome Steroid hormones steroid resistant nephrotic syndrome Tacrolimus |
| title | Rituximab in treatment of collapsing FSGS—A case series |
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