The efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid-dependent /frequently relapsing nephrotic syndrome: a retrospective follow-up study
Abstract Introduction Approximately 70%～90% of children with steroid-sensitive nephrotic syndrome (SSNS) will suffer from steroid dependency or frequent relapses, prompting the use of steroid-sparing agent. In this study, we investigate the efficacy and the characteristics of dynamic changes in immu...
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2025-04-01
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| Online Access: | https://doi.org/10.1186/s12882-025-04093-4 |
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| author | Songlei Gu Tong Shen Yihui Zhai Jie Yu Jie Niu Wenli Xu Yugui Zeng Qian Shen Hong Xu Xiaoqing Yang |
| author_facet | Songlei Gu Tong Shen Yihui Zhai Jie Yu Jie Niu Wenli Xu Yugui Zeng Qian Shen Hong Xu Xiaoqing Yang |
| author_sort | Songlei Gu |
| collection | DOAJ |
| description | Abstract Introduction Approximately 70%～90% of children with steroid-sensitive nephrotic syndrome (SSNS) will suffer from steroid dependency or frequent relapses, prompting the use of steroid-sparing agent. In this study, we investigate the efficacy and the characteristics of dynamic changes in immune function of two doses of rituximab (RTX) in the treatment of steroid-dependent/frequently relapsing nephrotic syndrome (SDNS /FRNS). Method Retrospective follow-up study was conducted in our hospital from June 2022 to September 2023. 7 children with SDNS /FRNS were allocated to intravenous 2 doses RTX (each dose 375mg/m2, 1 dose per week) and administered the standard oral dose of mycophenolate mofetil (MMF) (1000–1200/m2/d, divided into 2 doses) when B cells have recovered (≥ 5/ul). The study subjects after treatment were monitored for the efficacy and dynamic changes of immune function for 12 months. Result 7 children with SDNS/FRNS who were treated RTX with MMF and followed up for 12 months have no relapse. The rate of B cell depletion (< 5/ul) was 100% at 1 week after the second dose of RTX treatment, and the rate of B cell recovery was 100% at 5–12 months after the first dose of RTX treatment. There was no significant difference with T cell subsets (CD3, CD4, CD8, CD4/CD8) at each follow-up time points (all P > 0.05). The count of NK cells was significantly higher than that of other groups at 1 week after the second dose (P < 0.05). The IgM level at 1 week after the second dose was significantly lower than that before treatment and 1 week after the first dose (P < 0.05). There were no significant differences with IgA, IgG, C3 and C4 before treatment, 1 week after the first dose and 1 week after the second dose (all P > 0.05). Conclusion and recommendation Administering two doses of RTX along with the standard dose of MMF has been effective in maintaining remission for children with SDNS/FRNS. B cell depletion can be achieved one week after the second dose of RTX treatment. NK cell proliferation may play a role in B cell depletion, and early B cell depletion may suppress the production of IgM. These findings require further validation through additional clinical trials and basic research. |
| format | Article |
| id | doaj-art-aacf93f703e148739c392ef4f9612d1e |
| institution | OA Journals |
| issn | 1471-2369 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Nephrology |
| spelling | doaj-art-aacf93f703e148739c392ef4f9612d1e2025-08-20T02:11:41ZengBMCBMC Nephrology1471-23692025-04-0126111210.1186/s12882-025-04093-4The efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid-dependent /frequently relapsing nephrotic syndrome: a retrospective follow-up studySonglei Gu0Tong Shen1Yihui Zhai2Jie Yu3Jie Niu4Wenli Xu5Yugui Zeng6Qian Shen7Hong Xu8Xiaoqing Yang9Department of Pediatrics, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Pediatrics, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Nephrology, Children’s Hospital of Fudan UniversityPediatrics Department, Nanping Zhenghe County General HospitalDepartment of Pediatrics, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Pediatrics, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Pediatrics, Women and Children’s Hospital, School of Medicine, Xiamen UniversityDepartment of Nephrology, Children’s Hospital of Fudan UniversityDepartment of Nephrology, Children’s Hospital of Fudan UniversityDepartment of Pediatrics, Women and Children’s Hospital, School of Medicine, Xiamen UniversityAbstract Introduction Approximately 70%～90% of children with steroid-sensitive nephrotic syndrome (SSNS) will suffer from steroid dependency or frequent relapses, prompting the use of steroid-sparing agent. In this study, we investigate the efficacy and the characteristics of dynamic changes in immune function of two doses of rituximab (RTX) in the treatment of steroid-dependent/frequently relapsing nephrotic syndrome (SDNS /FRNS). Method Retrospective follow-up study was conducted in our hospital from June 2022 to September 2023. 7 children with SDNS /FRNS were allocated to intravenous 2 doses RTX (each dose 375mg/m2, 1 dose per week) and administered the standard oral dose of mycophenolate mofetil (MMF) (1000–1200/m2/d, divided into 2 doses) when B cells have recovered (≥ 5/ul). The study subjects after treatment were monitored for the efficacy and dynamic changes of immune function for 12 months. Result 7 children with SDNS/FRNS who were treated RTX with MMF and followed up for 12 months have no relapse. The rate of B cell depletion (< 5/ul) was 100% at 1 week after the second dose of RTX treatment, and the rate of B cell recovery was 100% at 5–12 months after the first dose of RTX treatment. There was no significant difference with T cell subsets (CD3, CD4, CD8, CD4/CD8) at each follow-up time points (all P > 0.05). The count of NK cells was significantly higher than that of other groups at 1 week after the second dose (P < 0.05). The IgM level at 1 week after the second dose was significantly lower than that before treatment and 1 week after the first dose (P < 0.05). There were no significant differences with IgA, IgG, C3 and C4 before treatment, 1 week after the first dose and 1 week after the second dose (all P > 0.05). Conclusion and recommendation Administering two doses of RTX along with the standard dose of MMF has been effective in maintaining remission for children with SDNS/FRNS. B cell depletion can be achieved one week after the second dose of RTX treatment. NK cell proliferation may play a role in B cell depletion, and early B cell depletion may suppress the production of IgM. These findings require further validation through additional clinical trials and basic research.https://doi.org/10.1186/s12882-025-04093-4RituximabNephrotic syndromeEfficacyImmunity |
| spellingShingle | Songlei Gu Tong Shen Yihui Zhai Jie Yu Jie Niu Wenli Xu Yugui Zeng Qian Shen Hong Xu Xiaoqing Yang The efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid-dependent /frequently relapsing nephrotic syndrome: a retrospective follow-up study BMC Nephrology Rituximab Nephrotic syndrome Efficacy Immunity |
| title | The efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid-dependent /frequently relapsing nephrotic syndrome: a retrospective follow-up study |
| title_full | The efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid-dependent /frequently relapsing nephrotic syndrome: a retrospective follow-up study |
| title_fullStr | The efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid-dependent /frequently relapsing nephrotic syndrome: a retrospective follow-up study |
| title_full_unstemmed | The efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid-dependent /frequently relapsing nephrotic syndrome: a retrospective follow-up study |
| title_short | The efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid-dependent /frequently relapsing nephrotic syndrome: a retrospective follow-up study |
| title_sort | efficacy and dynamic changes of immune function of rituximab with mycophenolate mofetil in the treatment of steroid dependent frequently relapsing nephrotic syndrome a retrospective follow up study |
| topic | Rituximab Nephrotic syndrome Efficacy Immunity |
| url | https://doi.org/10.1186/s12882-025-04093-4 |
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