Long-Term Outcomes of Rituximab-Treated Adult Patients with Podocytopathies

Key Points Fifty-five percent of patients achieve long-term remission after rituximab treatment. This is influenced by maintenance therapy with rituximab. A substantial reduction of annualized relapse rate and concomitant immunosuppression was observed after rituximab treatment. Background Long-term outcomes of rituximab-treated adult patients with podocytopathies (either minimal change disease or FSGS) are largely unknown. Methods A retrospective study at 30 nephrology departments from 15 countries worldwide included rituximab-treated adults with primary podocytopathies and a minimum clinical follow-up of 36 months. The primary outcome was relapse-free survival at 36 months. Results One hundred eighty-three adult patients ( n =64 with FSGS and n =119 with minimal change disease) with difficult-to-treat nephrotic syndrome (68% steroid-dependent/frequently relapsing, 22% steroid-resistant, 85% previously treated with two or more lines of immunosuppressive therapy) were treated with rituximab as part of a remission induction regimen. Complete or partial remission at 6 months after rituximab treatment was achieved in 82%. Eighty-three of 151 (55%) initial responders achieved long-term relapse-free survival over 3 years. Maintenance therapy with rituximab was associated with a better relapse-free survival (hazard ratio, 2.05; 95% confidence interval [CI], 1.07 to 3.91), irrespective of the dosing regimen. At 36 months, 61% of initial responders receiving maintenance therapy with rituximab achieved long-term relapse-free survival and withdrawal of all concomitant immunosuppressive medication compared with 36% of patients without maintenance treatment (odds ratio, 2.69; 95% CI, 1.27 to 5.73). Relapses per year were reduced from an annual relapse rate of 1.0 (95% CI, 1.0 to 1.7) before to 0.17 (95% CI, 0.00 to 0.24) relapses per year after rituximab initiation. Over the 36 months of follow-up, a stable course of eGFR was observed in those who initially responded with either complete or partial remission, whereas nonresponders experienced a reduction in eGFR reaching −11 (95% CI, −18 to −8) ml/min per 1.73 m 2 . Conclusions Rituximab facilitated achievement of initial and long-term response in a majority of adult patients with difficult-to-treat podocytopathies. Maintenance treatment with rituximab was further associated with long-term relapse-free survival over 3 years. Nonresponse to initial rituximab treatment was associated with poor kidney prognosis.

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Journal
Journal of the American Society of Nephrology
Published
2024-10-16
DOI
https://doi.org/10.1681/asn.0000000520
Citations
26
Primary Topic
Renal Diseases and Glomerulopathies
Type
article
Field-Weighted Citation Impact
8.82
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article

Long-Term Outcomes of Rituximab-Treated Adult Patients with Podocytopathies

Raja Ramachandran, Léa Hoisnard, Γεώργιος Λιούλιος, Andreas Kronbichler et al.
26 citations
Journal of the American Society of Nephrology
Renal Diseases and Glomerulopathies
8.82
article

Long-Term Outcomes of Rituximab-Treated Adult Patients with Podocytopathies

Raja Ramachandran, Léa Hoisnard, Γεώργιος Λιούλιος, Andreas Kronbichler, Natalia A. Chebotareva, Kültiğin Türkmen, Yonatan Peleg, Annette Bruchfeld, Kres̆imir Gales̃ić, Nikola Zagorec, Montserrat M. Díaz Encarnación, Karina Guaman, Chee Kay Cheung, Catherine King, Stanislas Faguer, Philipp Gauckler, Zdenka Hrušková, Anna Matyjek, Luis Fernando Quintana, Matija Crnogorac, Federico Alberici, Pilar Auñón, Martin Windpessl, Martin Busch, Balazs Odler, Ulf Schönermarck, Gema Fernández‐Juárez, Marios Papasotiriou, Leonella Luzardo, Loreto Fernández, Vladimı́r Tesař, Vincent Audard, Sofiane Salhi, Ayşe Serra Artan, Şafak Mirioğlu, Kathrin Eller, Jai Radhakrishnan, Μaria Stangou, Julio Pascual, Gert Mayer, Siân Griffin, Eleni Kapsia, Smaragdi Marinaki, David Ribes, Ruth J. Pepper, Clara García-Carro, Maxi Schaepe, Nina Krnanska
article en
26 citations

Abstract

Key Points Fifty-five percent of patients achieve long-term remission after rituximab treatment. This is influenced by maintenance therapy with rituximab. A substantial reduction of annualized relapse rate and concomitant immunosuppression was observed after rituximab treatment. Background Long-term outcomes of rituximab-treated adult patients with podocytopathies (either minimal change disease or FSGS) are largely unknown. Methods A retrospective study at 30 nephrology departments from 15 countries worldwide included rituximab-treated adults with primary podocytopathies and a minimum clinical follow-up of 36 months. The primary outcome was relapse-free survival at 36 months. Results One hundred eighty-three adult patients ( n =64 with FSGS and n =119 with minimal change disease) with difficult-to-treat nephrotic syndrome (68% steroid-dependent/frequently relapsing, 22% steroid-resistant, 85% previously treated with two or more lines of immunosuppressive therapy) were treated with rituximab as part of a remission induction regimen. Complete or partial remission at 6 months after rituximab treatment was achieved in 82%. Eighty-three of 151 (55%) initial responders achieved long-term relapse-free survival over 3 years. Maintenance therapy with rituximab was associated with a better relapse-free survival (hazard ratio, 2.05; 95% confidence interval [CI], 1.07 to 3.91), irrespective of the dosing regimen. At 36 months, 61% of initial responders receiving maintenance therapy with rituximab achieved long-term relapse-free survival and withdrawal of all concomitant immunosuppressive medication compared with 36% of patients without maintenance treatment (odds ratio, 2.69; 95% CI, 1.27 to 5.73). Relapses per year were reduced from an annual relapse rate of 1.0 (95% CI, 1.0 to 1.7) before to 0.17 (95% CI, 0.00 to 0.24) relapses per year after rituximab initiation. Over the 36 months of follow-up, a stable course of eGFR was observed in those who initially responded with either complete or partial remission, whereas nonresponders experienced a reduction in eGFR reaching −11 (95% CI, −18 to −8) ml/min per 1.73 m 2 . Conclusions Rituximab facilitated achievement of initial and long-term response in a majority of adult patients with difficult-to-treat podocytopathies. Maintenance treatment with rituximab was further associated with long-term relapse-free survival over 3 years. Nonresponse to initial rituximab treatment was associated with poor kidney prognosis.

Journal of the American Society of NephrologyVol. 36(4)
Linköping University (SE), National Academy of Medicine (US), Karolinska University Hospital (SE), Innsbruck Medical University (AT), University of Leicester (GB), Inserm (FR), Sechenov University (RU), Universidad de la República de Uruguay (UY), University of Zagreb (HR), Université Paris-Est Créteil (FR), Medical University of Graz (AT), Charles University (CZ), Aristotle University of Thessaloniki (GR), Columbia University Irving Medical Center (US), Hospital Universitario La Paz (ES), University Hospital Dubrava (HR), University Hospital of Wales (GB), The Royal Free Hospital (GB), General University Hospital of Patras (GR), University Hospitals of Leicester NHS Trust (GB), Karolinska Institutet (SE), Hospital Clínico San Carlos (ES), LMU Klinikum (DE), Centre Hospitalier Universitaire de Toulouse (FR), Assistance Publique – Hôpitaux de Paris (FR), Complejo Hospitalario de Navarra (ES), Hospital Universitario 12 De Octubre (ES), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Hospital La Paz Institute for Health Research (ES), Fédération Hospitalo-Universitaire, Paris Center for Microbiome Medicine (FR), Necmettin Erbakan University (TR), Laiko General Hospital of Athens (GR), Hospital Clínic de Barcelona (ES), Ippokrateio General Hospital of Thessaloniki (GR), Medical University of Lodz (PL), Klinikum Wels-Grieskirchen (AT), Hôpitaux Universitaires Henri-Mondor (FR), Puigvert Foundation (ES), Institut des Maladies Métaboliques et Cardiovasculaires (FR), Centre d'Investigation Clinique - Innovation Technologique (FR), Hospital de Clínicas (UY), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), General University Hospital in Prague (CZ), Hippocration General Hospital (GR), Centre d’Investigation Clinique 1436 (FR), Epidemiology in dermatology and evaluation of therapeutics, University College London (GB), Post Graduate Institute of Medical Education and Research (IN), Istanbul University (TR), Universitat de Barcelona (ES), Friedrich Schiller University Jena (DE), University of Birmingham (GB), University of Brescia (IT), Ludwig-Maximilians-Universität München (DE)
Openalex Percentile: Top 1%
Renal Diseases and Glomerulopathies
8.82
DOISourceOpenAlex
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