Observation of rituximab as initial treatment in patients with minimal change disease-a retrospective study

Sha Wang Hua Liang Li Luyao Cheng Miaomiao Fang-Yi Lv Li Zong Ke Zhao Xiangdong Yang ^* Xiaoyan Xiao ^*

• Qilu Hospital, Shandong University, Jinan, Shandong Province, China

Research BackgroundThis study was aimed to retrospectively investigate the efficacy and safety of rituximab (RTX) versus glucocorticoids (GC) as initial treatments for patients with minimal change disease (MCD).Research MethodsPatients who were diagnosed with MCD through kidney biopsy and received RTX or GC as the initial treatment regimen were included and matched by propensity score (ratio: 1:1) based on age, sex, urine protein, and eGFR(each group: 12 adults, 2 children). Outcomes included 24-week clinical remission rate, time to remission, relapse-free survival, relapse rate, changes in urine protein-to-creatinine ratio (UPCR), serum albumin levels, and adverse events.Research ResultsAll 28 patients (100.00%) achieved clinical remission, with 22 patients (78.57%) achieving complete remission (CR) and 6 patients (21.43%) achieving partial remission (PR) at 24-week. The median time to remission was 5 (3-7) weeks. During the 24-week follow-up, the RTX group and the GC group each had 2 patients with recurrence, resulting in a relapse rate of 14.29%. Both the RTX group and the GC group had 14 patients (100%) achieve clinical remission, with 11 patients (78.57%) reaching CR and 3 patients (21.43%) achieving PR. The median time to remission in the RTX group was 5 (3-7) weeks, while in GC group, it was 5 (3-8) weeks (p=0.728). Follow-up results at 24 weeks indicated that the UPCR levels for all MCD patients decreased from an average of 8.93 (range 6.13-17.48) g/g to 0.07 (range 0.03-0.28) g/g, with no statistically significant difference between 2 groups (P=0.945). Serum albumin levels increased from 18.60 ± 7.54 g/L to 44.39 ± 4.50 g/L, with no significant intergroup difference (P=0.601). In the RTX group, patients tolerated RTX well, with only 1 case of tachycardia occurring during infusion, which resolved spontaneously after reducing the infusion rate. In the GC group, there were no severe adverse reactions reported. However, 10 patients experienced weight gain, 3 patients exhibited elevated blood glucose levels, 2 patients presented with skin striae, and 1 patient showed elevated transaminases.ConclusionRTX demonstrated comparable efficacy to GC in inducing/remission maintenance for MCD, with better tolerability. It is a promising first-line alternative, especially for pediatric patients.