Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent/frequently relapsing nephrotic syndrome in children: a case series
BackgroundRituximab (RTX) has gradually been accepted as a treatment for frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS) in children, but no standardized recommendations for the dosage and combination therapy exist. Additionally, the efficacy and safety...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2025.1646837/full |
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| author | Jide Song Hong Chang Yi Lin Chunrong Shan Jia Liu Ranran Zhang Nana Nie Cui Bai Shan Gao Qiuye Zhang Dahai Wang |
| author_facet | Jide Song Hong Chang Yi Lin Chunrong Shan Jia Liu Ranran Zhang Nana Nie Cui Bai Shan Gao Qiuye Zhang Dahai Wang |
| author_sort | Jide Song |
| collection | DOAJ |
| description | BackgroundRituximab (RTX) has gradually been accepted as a treatment for frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS) in children, but no standardized recommendations for the dosage and combination therapy exist. Additionally, the efficacy and safety of low-dose RTX in FRNS/SDNS remain unclear, although it has been used to treat some autoimmune diseases.MethodsWe report a case series of 24 children diagnosed with FRNS/SDNS treated with low-dose RTX followed by mycophenolate mofetil (MMF) for maintenance of remission of nephrotic syndrome between August 2021 and February 2023. These patients were followed up for at least 12 months.ResultsThe mean total dose for the initial four administrations of low-dose RTX was 470.83 ± 62.41 mg, which was significantly lower than the calculated values for one standard dose (525.62 ± 125.62 mg; P = 0.006) and two standard doses (1051.2 ± 251.23 mg; P < 0.001). After treatment initiation, the median follow-up was 24.6 (16.8, 28.5) months. At the 1-year follow-up, no child had experienced treatment failure, and the relapse-free rate was 83.3%. At the last follow-up, two children had experienced treatment failure, with both having frequent relapses, and the relapse-free rate was 75%. Compared with the calculated standard dose of RTX, low-dose RTX followed by MMF was less costly. No serious adverse reactions were observed during RTX use or follow-up, except for one death due to delayed treatment of severe infection.ConclusionLow-dose RTX followed by MMF can extend the remission duration of FRNS/SDNS in children, and decrease the economic burden on families, while offering good safety. |
| format | Article |
| id | doaj-art-9cbe64b7347648bd99b14f4bcf31f5e3 |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj-art-9cbe64b7347648bd99b14f4bcf31f5e32025-08-26T05:28:02ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-08-011610.3389/fphar.2025.16468371646837Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent/frequently relapsing nephrotic syndrome in children: a case seriesJide Song0Hong Chang1Yi Lin2Chunrong Shan3Jia Liu4Ranran Zhang5Nana Nie6Cui Bai7Shan Gao8Qiuye Zhang9Dahai Wang10Department of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatrics, Qingdao Women and Children’s Hospital, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaDepartment of Pediatric Nephrology, Rheumatology, and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, ChinaBackgroundRituximab (RTX) has gradually been accepted as a treatment for frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS) in children, but no standardized recommendations for the dosage and combination therapy exist. Additionally, the efficacy and safety of low-dose RTX in FRNS/SDNS remain unclear, although it has been used to treat some autoimmune diseases.MethodsWe report a case series of 24 children diagnosed with FRNS/SDNS treated with low-dose RTX followed by mycophenolate mofetil (MMF) for maintenance of remission of nephrotic syndrome between August 2021 and February 2023. These patients were followed up for at least 12 months.ResultsThe mean total dose for the initial four administrations of low-dose RTX was 470.83 ± 62.41 mg, which was significantly lower than the calculated values for one standard dose (525.62 ± 125.62 mg; P = 0.006) and two standard doses (1051.2 ± 251.23 mg; P < 0.001). After treatment initiation, the median follow-up was 24.6 (16.8, 28.5) months. At the 1-year follow-up, no child had experienced treatment failure, and the relapse-free rate was 83.3%. At the last follow-up, two children had experienced treatment failure, with both having frequent relapses, and the relapse-free rate was 75%. Compared with the calculated standard dose of RTX, low-dose RTX followed by MMF was less costly. No serious adverse reactions were observed during RTX use or follow-up, except for one death due to delayed treatment of severe infection.ConclusionLow-dose RTX followed by MMF can extend the remission duration of FRNS/SDNS in children, and decrease the economic burden on families, while offering good safety.https://www.frontiersin.org/articles/10.3389/fphar.2025.1646837/fullrituximabmycophenolate mofetilfrequently relapsing nephrotic syndromesteroid-dependent nephrotic syndromechildren |
| spellingShingle | Jide Song Hong Chang Yi Lin Chunrong Shan Jia Liu Ranran Zhang Nana Nie Cui Bai Shan Gao Qiuye Zhang Dahai Wang Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent/frequently relapsing nephrotic syndrome in children: a case series Frontiers in Pharmacology rituximab mycophenolate mofetil frequently relapsing nephrotic syndrome steroid-dependent nephrotic syndrome children |
| title | Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent/frequently relapsing nephrotic syndrome in children: a case series |
| title_full | Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent/frequently relapsing nephrotic syndrome in children: a case series |
| title_fullStr | Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent/frequently relapsing nephrotic syndrome in children: a case series |
| title_full_unstemmed | Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent/frequently relapsing nephrotic syndrome in children: a case series |
| title_short | Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent/frequently relapsing nephrotic syndrome in children: a case series |
| title_sort | low dose rituximab followed by mycophenolate mofetil for steroid dependent frequently relapsing nephrotic syndrome in children a case series |
| topic | rituximab mycophenolate mofetil frequently relapsing nephrotic syndrome steroid-dependent nephrotic syndrome children |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1646837/full |
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