Positive role of rituximab in switching from cyclosporine to mycophenolate mofetil for children with high-dose steroid-dependent nephrotic syndrome
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- 作者：Shuichiro Fujinaga ; Koji Sakuraya ; Akifumi Yamada…
- 刊名：Pediatric Nephrology
- 出版年：2015
- 出版时间：April 2015
- 年：2015
- 卷：30
- 期：4
- 页码：687-691
- 全文大小：190 KB
- 参考文献：1. Ishikura K, Yoshikawa N, Hattori S, Sasaki S, Iijima K, Nakanishi K, Matsuyama T, Yata N, Ando T, Honda M (2010) Treatment with microemulsified cyclosporine in children with frequently relapsing nephrotic syndrome. Nephrol Dial Transplant 25:3956-962 CrossRef
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文摘
Background Recent randomized studies indicate that mycophenolate mofetil (MMF) is inferior to cyclosporine (CsA) in preventing relapses of nephrotic syndrome (NS). During the last decade, rituximab (RTX) has emerged as a rescue therapy in patients with complicated, frequently relapsing, or steroid-dependent NS. Case-Diagnosis/Treatment After introducing RTX in our single center, we analyzed 26 patients with steroid-dependent NS who had relapses while receiving long-term CsA and who were subsequently switched to MMF. MMF was adjusted to maintain a targeted predose mycophenolic acid (MPA) level of 2-?μg/ml. Moreover, for patients who required MMF and high-dose prednisolone (PSL) to maintain remission, a single infusion of RTX (375?mg/m2) was added. The primary endpoint was the probability of achieving PSL-free remission for >1?year. At a mean follow-up of 28.8?±-.9?months, 11 of 26 patients (42?%) required RTX treatment, and 22 of those patients (85?%) achieved PSL-free sustained remission. The mean predose MPA levels for patients who achieved PSL-free sustained remission were significantly higher compared with those for patients who did not (3.1?μg/ml vs. 1.7?μg/ml, p--.05). Conclusions After RTX introduction, most patients were able to switch from CsA to MMF and achieve sustained PSL-free remission.