USING MONOCLONAL ANTIBODIES IN THE TREATMENT OF STEROID-SENSITIVE NEPHROTIC SYNDROME IN CHILDREN
Keywords:
Nephrotic syndrome, rituximab, steroid-sensitive nephrotic syndrome, B-cell depletion, immunosuppression, CD20Abstract
Introduction. Nephrotic syndrome (NS) is one of the most common glomerular diseases in childhood. Although corticosteroids remain the cornerstone of initial therapy, approximately 50% of affected children develop frequently relapsing or steroid-dependent disease. In cases refractory to conventional immunosuppressive agents, rituximab - a chimeric anti-CD20 monoclonal antibody - has emerged as a promising therapeutic option.
Aim. To evaluate the efficacy of rituximab in achieving sustained remission in children with steroid-sensitive nephrotic syndrome and to identify clinical predictors of favourable treatment outcomes.
Methods. A prospective study enrolled 85 children with primary NS treated at the National Children's Medical Centre between 2021 and 2025. All patients received two rituximab infusions (750 mg/m²) administered 14 days apart; those maintaining remission received repeated infusions every six months (three courses total). Statistical analysis included the Mann–Whitney U test for continuous variables and Fisher's exact test with odds ratio (OR) calculation for categorical data.
Results. Sustained remission was achieved in 68 patients (80%); post-treatment relapse occurred in 33 children (38.8%). Statistically significant predictors of remission included older age at disease onset (5.07 vs 3.49 years; p=0.023), older age at the time of rituximab administration (11.57 vs 8.90 years; p=0.013), and low pre-treatment relapse frequency (p=0.010). Continued immunosuppressive therapy after rituximab was associated with lower odds of remission (OR=0.172; 95% CI: 0.053–0.560; p=0.004), most likely reflecting confounding by indication. Gender, biopsy findings, and disease duration prior to treatment were not significant predictors. No serious adverse events were recorded; mild infusion reactions occurred in 7.1% of patients.
Conclusion. Rituximab is a highly effective and well-tolerated treatment for steroid-sensitive nephrotic syndrome in children, achieving sustained remission in 80% of patients with a six-monthly re-dosing protocol. Older age at disease onset, older age at first infusion, and low pre-treatment relapse frequency are associated with favourable outcomes. Prospective studies are needed to optimise dosing regimens and re-treatment intervals.
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