Rituximab effective Steroid-Sparing Treatment of steroid-dependent or frequently relapsing nephrotic syndrome: BMC

A new study published in the journal of BMC Nephrology revealed rituximab to be an effective and safe steroid sparing medication in individuals with steroid dependent (SD)/frequent relapsing (FR) nephrotic syndrome (NS). Longer remission is attained when a follow-up maintenance dosage is administered following the initial course.

According to the Kidney Disease: Improving Global Outcome (KDIGO) guidelines, glucocorticoid medication is advised as the first-line treatment for adult MCD since it has a positive prognosis. Although 75–90% of patients get a full response, up to 25% of steroid responders experience frequent relapses (FR), and 30–40% acquire steroid dependence.

Although corticosteroids are very effective in treating minimal change disease, many individuals develop steroid dependence or relapse often. Primary Focal Segmental Glomerulosclerosis (FSGS) has a lower response rate. An efficient substitute is needed as extended exposure to corticosteroids should be avoided and in this context, Rituximab is an agent with promise. Omri Feder and colleagues conducted a review to assess long-term safety and effectiveness of Rituximab therapy in adult patients with SD/FR NS.

This retrospective cohort research that assessed Rituximab-treated SD/FR NS patients at a tertiary institution. Rituximab was administered during induction, and the treating nephrologist made the choice about further dosages. Relapse frequency and time to first relapse were the main outcomes. Safety was evaluated.

There were 21 adults in total and out of these, 2 instances had no kidney biopsies, 5 (23.8%) had FSGS, and 14 (66.7%) had MCD. 54.6 years was the median age while 39.6 months was the median follow-up period. Rituximab significantly reduced the number of relapses when compared to prior therapy (median relapses were 0 versus 3, respectively, W = 3.70, p <.001). Before Rituximab, the time to first relapse was substantially shorter than after (median 11 vs. 536 days, respectively, W = 3.05, p =.002).

The patients who got a single course of Rituximab had a greater hazard ratio for recurrence than those who received further maintenance. Although the treatment was generally tolerated, severe COVID-19 and cholecystitis were among the significant side effects. Overall, in individuals with SD/FR NS, rituximab seems to be a safe and effective substitute for extended steroid therapy. Also, lengthier remission is attained when a follow-up maintenance dosage is administered following the first course.

Source:

Feder, O., Amsterdam, D., Ershed, M., Grupper, A., Schwartz, D., & Kliuk-Ben Bassat, O. (2025). Long-term efficacy of Rituximab in steroid dependent and frequent relapsing adult nephrotic syndrome. BMC Nephrology, 26(1), 126. https://doi.org/10.1186/s12882-025-04035-0