医学
美罗华
肾病综合征
泼尼松龙
肾病科
微小变化病
内科学
维持疗法
胃肠病学
局灶节段性肾小球硬化
蛋白尿
甲基强的松龙
移植
泌尿科
强的松
肾功能
外科
不利影响
化疗
肾小球肾炎
肾
淋巴瘤
作者
Shuichiro Fujinaga,Daishi Hirano,Naoto Nishizaki,Koichi Kamei,Shuichi Ito,Yoshiyuki Ohtomo,Toshiaki Shimizu,Kazunari Kaneko
标识
DOI:10.1007/s00467-009-1377-5
摘要
Rituximab (RTX) has been successfully used as a rescue therapy in children with steroid-dependent nephrotic syndrome (SDNS). However, little is known regarding maintenance therapy after a successful response to RTX in such patients. The efficacy and safety of a single RTX infusion (375 mg/m(2)) were assessed in ten patients who had persistent SDNS associated with minimal-change disease (MCD) despite the long-term use of cyclosporine (CsA). The mean follow-up after RTX infusion was 17 months. Applying RTX resulted in a significant reduction in the mean prednisolone (PSL) dose from 0.39 +/-0.18 to 0.15 +/- 0.14 mg/kg per day. The mean 12-month relapse rates significantly decreased from 4.1 +/- 1.7 to 0.6 +/- 0.6. All but one patient who had continued CsA as maintenance therapy after a single RTX infusion were able to withdraw from PSL without any relapses during the study period, whereas the remaining five patients who discontinued CsA experienced relapses after CD19 cells re-emerged, leading to the reintroduction of CsA or an additional RTX infusion. Infusion reactions occurred in five of ten patients. These data indicate that a single RTX infusion may improve response to CsA in patients with persistent SDNS due to the phenomenon of secondary resistance to CsA.
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