DOSING, EFFICACY AND SAFETY OF RITUXIMAB FOR THE TREATMENT OF MINIMAL CHANGE DISEASE IN ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Dr Sanjana Dang1,2,3, DR SHAUN CHANDLER1,2,3, DR RYAN GATELY1,3, A/PROF YOUNGJEE CHO1,3, A/PROF NICOLE ISBEL1,3
1Department of Kidney and Transplant Services, Princess Alexandra Hospital, , Australia, 2Royal Brisbane And Women’s Hospital, , Australia, 3University of Queensland, , Australia
Aim: To examine dosing, efficacy and safety of rituximab in treating minimal change disease (MCD) in adults.
Background: MCD causes 10-15% of nephrotic syndrome in adults with propensity to relapse. High-dose corticosteroids are first-line, while other immunosuppressants are reserved for frequently-relapsing (FRMCD), steroid-dependent (SDMCD) or resistant (SRMCD) disease. Rituximab, an anti-CD20 monoclonal antibody, offers potential benefits by reducing corticosteroid exposure, costs and improving tolerability/compliance.
Methods: This review is registered with PROSPERO and complies with PRISMA guidelines. PubMed, EMBASE, CINAHL, Cochrane and CKN databases were searched. Inclusion criteria was age (≥16 years), cohort size (n≥2), native kidney biopsy-proven MCD, follow-up (≥6 months) and induction (FRMCD, SDMCD, SRMCD or initial treatment). We defined subgroups of “low-dose (cumulative induction dose (CID) = single-dose 375mg/m2 or ≤1g)” and “high-dose (CID >1g)” rituximab. Using a random-effects model, meta-analysis was performed to evaluate the pooled proportion achieving complete remission and subgroup meta-analysis compared high- and low-dose groups.
Results: 33 observational or single-arm trials were included (n=447; 37% female), primarily from Europe (45%) and Asia (33%). The pooled complete remission (CR) was 0.80 (0.74-0.85) for the total cohort. Despite CID being variable, the low-dose group demonstrated CR 0.85 (0.74-0.91) and high-dose CR 0.77 (0.69-0.83). At 12 months, CR was 80% (low-dose) and 61% (high-dose). 69% (low-dose) were steroid-free at last follow-up compared to 61% (high-dose). An Australian study (n=11, 2020), achieved 100% CR by 4 weeks following one-off 500mg rituximab, with 73% maintaining remission at 12 months. Reported adverse events were minimal overall.
Conclusion: Rituximab is safe and efficacious for treating MCD in adults, and current review demonstrates that low-dose rituximab is as effective as high-dose.
Presentation Slides PDF – Click here
Biography:
Dr Sanjana Dang is an advanced trainee in nephrology, currently placed at Royal Brisbane and Women’s Hospital. She has a keen interest in glomerular diseases and is a course instructor with the GlomCon Fellowship team for Australiasia (Podocin).