B A MARSH1, J LLOYD2, J RANKINE2, S YEE AW3, Y CHO1, D JOHNSON1, C HAWLEY1, A K VIECELLI1, R FRANCIS1, N ISBEL1
1Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, 2Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Australia, 3The School of Pharmacy, University of Queensland, Brisbane, Australia
Background: Minimal change disease (MCD) accounts for 15% of idiopathic nephrotic syndrome in adults and is treated with corticosteroids as first-line therapy. In relapsing MCD, rituximab at doses of 375mg/m2, and total treatment courses ranging from 1-4 infusions has been shown to induce remission, but studies to establish the minimum effective dose are lacking.
Aim: To describe our centre’s experience with using fixed, low dose rituximab as induction treatment for patients with relapsing MCD.
Methods: We retrospectively reviewed outcomes of patients with relapsing MCD treated with a single, low dose (500mg) of rituximab. The primary outcome was proportion of patients achieving complete remission. Secondary outcomes included duration of remission maintenance, concomitant immunosuppressant use and adverse effects.
Results: Eleven patients (8 females, median age 32 years) were included. Their median duration of MCD was 3.9years (range 5 months to 12 years) with a median of 2 relapses (range 1-6) prior to rituximab. Following rituximab, all patients achieved remission, within a median period of 4 weeks (range 1-6 weeks). Remission was sustained in 8 (73%) of 11 patients over a median follow-up period of 78 weeks. Three (27%) patients experienced relapse after a median period of 78 weeks (interquartile range 48 – 147) and two of these occurred in individuals who had been completely weaned off corticosteroids. Minor Infusion related adverse effects occurred in 8 (73%) patients, including flushing, throat irritation.
Conclusions: In patients with relapsing MCD, administration of a single dose of 500 mg rituximab achieved sustained, complete remission in 73% of cases. This may be an effective treatment strategy for relapsing MCD to reduce costs, exposure to corticosteroid and other immunosuppression and associated side effects.
Dr Bree Marsh is a passionate nephrology advanced trainee currently employed at The Princess Alexandra Hospital in Brisbane. There she enjoys working in a multi-disciplinary team focusing on evidence-based patient care and early research. Her interests include further exploring the interplay between the immune system and kidney disease.