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ORIGINAL RESEARCH article

Front. Pharmacol.
Sec. Renal Pharmacology
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1403562

The efficacy and safety of half-dose of glucocorticoid combined with Rituximab versus high-dose of glucocorticoid for initial treatment of Minimal change disease: a single-center experience

Provisionally accepted
Peng Yan Peng Yan 1,2*Xueting Li Xueting Li 2Lu Zhang Lu Zhang 2Wei Qiao Wei Qiao 3Zhengbiao Xue Zhengbiao Xue 4Xiangdong Fang Xiangdong Fang 2Ben Ke Ben Ke 2Shuying Zhu Shuying Zhu 2
  • 1 Second Affiliated Hospital of Nanchang University, Nanchang, China
  • 2 Jiangxi Medical College, Shangrao, China
  • 3 Nanchang Normal University, Nanchang, China
  • 4 First Affiliated Hospital of Gannan Medical University, Ganzhou, China

The final, formatted version of the article will be published soon.

    Background: Minimal change disease (MCD) is a podocytopathy more commonly seen in children, but it also accounts for 10%-25% of adult nephrotic syndrome. High-dose oral glucocorticoids was recommended for initial treatment of MCD. However, long-term use of systemic corticosteroids is associated with significant adverse events, such as steroid-induced diabetes and infections. The aim of this study was to investigate the clinical efficacy and safety of half-dose glucocorticoids combined with rituximab (RTX) for the initial treatment of MCD.We recruited 74 patients with MCD confirmed by renal biopsy. 20 patients were treated with RTX alone with 1000mg at d1 and d15, 28 patients were received half-dose prednisolone (0.5mg/kg) per day combined with RTX with 1000mg at d1, and 26 patients received high-dose prednisolone (1mg/kg) per day. Treatment responses, including complete remission (CR) and partial remission (PR), and outcome adverse events such as steroid-induced diabetes, infections were compared among the three groups after 12 months of follow-up.Results: At 12-month follow-up, the CR rates were 50%, 96.4%, and 96.2% for the RTX group, half-dose prednisolone combined with RTX group, and high-dose prednisolone group, respectively.There was no statistical difference between half-dose prednisolone combined with RTX group and high-dose prednisolone group on CR and PR, and kidney function (P > 0.05). Compared with the high-dose prednisolone group, the half-dose prednisolone combined with RTX group reduced the incidence of adverse events of steroid diabetes (P = 0.041), especially in patients older than 55 years of age.The efficiency of half-dose prednisolone combined with RTX is not inferior to the recommended treatment regimen, and this regimen can effectively reduce the incidence of steroid-induced diabetes in patients with MCD. Moreover, we recommend a half-dose prednisolone combined with RTX treatment for the elderly patients with MCD.

    Keywords: minimal change disease, Glucocorticoids, rituximab, RTX, MCD

    Received: 19 Mar 2024; Accepted: 10 Dec 2024.

    Copyright: © 2024 Yan, Li, Zhang, Qiao, Xue, Fang, Ke and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Peng Yan, Second Affiliated Hospital of Nanchang University, Nanchang, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.