Therapeutic efficacy of low-dose rituximab for steroid-dependent minimal-change nephrotic syndrome in adults

Objective To explore the therapeutic efficacy of low-dose rituximab(RTX) for a relapse of steroid-dependent minimal-change nephrotic syndrome(SDMCNS) in adults. Methods From November 2018 to December 2019, 8 male SDMCNS patients were retrospectively analyzed. They received low-dose RTX treatment and were followed up for over 18 months. Results The median age was 28.5(18-53) years and the median follow-up period 24.5(18-28) months. And 5 and 3 cases received 2 and 3 intermittent doses of RTX 0.375 g/m² respectively. None of them had a relapse within 1 year. RTX 0.375 g/m² was repeated for 4 cases when CD19⁺ B-cell count dropped to 6. No relapse occurred at the end of follow-up period. A comparison of clinical data at 1 year before and after RTX dosing, hormone dose declined. At the end of follow-up period, the maintenance dose was 7.5(0-20) mg/d. Two discontinued horome and frequency of relapse/hospitalization and incidence of complications decreased markedly. Except for skin rash and pruritus in one case, the remainders had no obvious adverse effects. Conclusion For SDMCNS in adults, using low-dose RTX may be repeated based upon monitoring CD19⁺ B-cell count. Such a regimen may lower the frequency of relapse and reduce economic expenditures with fewer side effects.