Successful Use of Rituximab in Patients with IgA Nephropathy and Podocytopathy: A Case Series

Background: IgA nephropathy (IgAN) with podocytopathy is a rare pathological type of glomerular disease. The use of rituximab (RTX) in the treatment of glomerular diseases has increased in recent decades, but the efficacy of rituximab in the treatment of IgAN with podocytopathy has rarely been reported. Methods: A single-center retrospective study of IgAN patients with podocytopathy who were treated with RTX as second-line therapy was conducted at our center from 2019 to 2022.The aim of this study was to investigate the efficacy and safety of RTX in IgAN patients with podocytopathy. Results: Seven out of eight patients met the criteria for complete remission following RTX therapy. Only one patient had adverse events (infectious diarrhea and pulmonary infection). Seven patients had complete remission at the time of the last follow-up, and 1 patient experienced relapse six months after RTX therapy. The maximum relapse time after RTX therapy was 20 months, while the maximum relapse-free time before RTX therapy was only 6 months. The number of relapses before RTX therapy (per year) was 1-4; however, seven patients did not relapse and maintained remission at the last follow-up despite steroid withdrawal after RTX therapy. Conclusion: Overall, RTX effectively reduced proteinuria, increased the maximum relapse-free time and reduced the number of relapses per year and helped patients stop steroid use as soon as possible. RTX also helped most patients achieve clinical remission. RTX appears to be an effective and safe alternative for IgAN patients with podocytopathy with steroid dependance or frequent relapse. Funding: Clinical Revenue Support, Government Support – Non-U.S.