Multi-Drug Therapy Followed By Rituximab in Children with Refractory Nephrotic Syndrome Contributors
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 1
Abstract
Introduction: Over the last few years, rituximab (RTX) has emerged as a second- line therapy and has shown a 40-48% response rate in steroid resistant and up to 80% remission rate in steroid dependent nephrotic syndrome. The better outcome of RTX therapy in dependent nephrotic syndrome compared to resistant nephrotic syndrome is possibly due to excessive loss of RTX in the urine during active state of proteinuria. Objective: To assess the therapeutic response of RTX during non-proteinuric state in children with steroid and CNIs/MMF resistance nephrotic syndrome following induction of remission by a combined therapy of Prednisolone, CNIs and MMF. Materials and Methodology: In this study we analysed the data of steroid and CNIs/MMF –resistance idiopathic nephrotic children, aged 1-14 years from January 2014 to January 2016. The clinical decision was to treat those patients with a combined therapy (Prednisolone+CNI+MMF) to achieve remission, followed by treatment with RTX at a dose of 375 mg/m2 body surface area per week for two to four weeks. Five children those who responded to triple regimen were treated with two to four doses of RTX and were followed up for minimum six months following RTX therapy. Post RTX therapy, CNI and prednisolone dose was tapered. Results and Discussion: The characteristics of the five patients and follow-up data were documented Patient 1 and 2 were twin brothers. At six months follow-up, four patients achieved complete remission (80%) and three patients (60%) were completely off medications without any serious adverse effects. Conclusion: Ourstudy showed improved RTX efficacy during non-proteinuric state of refractory nephrotic syndrome. However, as intense immunosuppression may cause serious adverse event further study for evaluatinglong-term efficacy and safety of multidrug therapy are needed.
Authors and Affiliations
r. Saroj Kumar Satpathy, Dr. Subal Kumar Pradhan, Dr. Akhil Krishnamoorthy, Dr. Shreesh Bhat
Keywords
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- EP ID EP262843
- DOI 10.9790/0853-1701010
- Views 68
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