6763 Efficacy of rituximab in childhood onset steroid dependent nephrotic syndrome : a single centre experience from India

Objectives A high proportion of children with idiopathic nephrotic syndrome have steroid dependence (SDNS) with a relapsing course, drug toxicity & multiple infections.¹ Rituximab, a chimeric monoclonal anti-CD20 antibody is documented as a steroid sparing agent that helps drug withdrawal & improved growth.² As the data in our part of population is scarce, we planned to study the same in children with SDNS. Hence the objectives were to assess effect of rituximab in inducing sustained remission in SDNS and the effect of rituximab in reducing immunosuppressants. Also to compare cumulative steroid dose, growth velocity & side effects pre and post rituximab. Methods A prospective cohort study was conducted in a tertiary care teaching hospital from south India, in children between 1–18 years with SDNS, who had received rituximab two doses, (375mg/m²) as per standard protocol during a 2-year period from January 2020. Secondary/Congenital NS and eGFR ≤60 ml/mt were excluded. Demographic & clinical profiles were noted. 1 year follow up was done to assess for sustained remission, relapses, cumulative steroid dose, alternate immunosuppressants, growth, BMI and eGFR. Categorical and quantitative variables were expressed as frequency and mean ± SD respectively. Paired t test to compare quantitative parameters between time periods. Results 36 patients with were enrolled with a mean age of 11.8± 4.1 years with male preponderance. 34 patients had a renal biopsy diagnosis and 78% had minimal change disease. After rituximab therapy remission was sustained in 69%. Number of relapses/patient/year reduced from 3(2,3.75) to 0(0,1) post rituximab. 42% were withdrawn from immunosuppressants at 1-year post-rituximab. Mean cumulative steroid dose was 224.5 ±133 mg/kg & 43±47.2 mg/kg pre and post rituximab respectively (p <0.01). Mean height velocity was 2.3cm/year pre-rituximab as compared to 7.5cm/year post-rituximab with increment in height velocity of 5.2cm (p < 0.01). There was significant reduction in obesity (61% pre-Vs 25% post) and antihypertensive drug requirement. The study flow chart is shown in figure 1. Figure 2 shows Box whisker plots showing the no. of relapses, height velocity & cumulative steroid dose 1 year before and after giving rituximab in children with SDNS. Conclusion Rituximab induced sustained remission in SDNS. There was significant reduction in relapses, immunosuppressant requirement, cumulative steroid dose, obesity improvement in height velocity. References Mehmet Taşdemιr, et al. Rituximab treatment for difficult-to-treat nephrotic syndrome in children: a multicenter, retrospective study, Turkish Journal of Medical Sciences, 13.02.2021. Kazumoto Iijima, et al. Rituximab in steroid-sensitive nephrotic syndrome: lessons from clinical trials, Pediatr Nephrol, 2018;33:1449–1455.