Abstract: TH-OR93
Long-Term Outcomes of Rituximab-Treated Adults with Primary Podocytopathies
Session Information
- Podocytopathies and Membranous Nephropathy: Clinical Advances
October 24, 2024 | Location: Room 1, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Gauckler, Philipp, Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
- Matyjek, Anna, Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
- Mayer, Gert J., Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
- Kronbichler, Andreas, Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
Group or Team Name
- RITERM Study Group.
Background
Long-term outcomes of rituximab-treated adult patients with primary podocytopathies (either minimal change disease or focal segmental glomerulosclerosis) are largely unknown.
Methods
A retrospective study at 30 nephrology departments from 15 countries worldwide included rituximab-treated adults with primary podocytopathies and a minimum follow-up of 36 months. The primary outcome was relapse-free survival at 36-months.
Results
Of 183 rituximab-treated adults with difficult-to-treat nephrotic syndrome (68% steroid-dependent/frequently relapsing, 22% steroid-resistant, 84% previously treated with two or more lines of immunosuppressive therapy), complete or partial remission at 6 months after rituximab treatment was achieved in 83%. Eighty-three of 151 (55%) initial responders achieved long-term relapse-free survival over three years. Maintenance therapy with rituximab was associated with a better relapse-free survival (HR 2.05, 95% CI: 1.07-3.91). Relapses per year were reduced from an annual rate of 1.0 relapses/year before to 0.17 relapses/year after rituximab initiation (p < 0.001). During follow-up, a stable course of estimated glomerular filtration rate was observed in patients with initial treatment response, whereas non-responders experienced a reduction in eGFR reaching -11 (-33 to -6) mL/min/1.73m2 (p < 0.001). Concomitant immunosuppressive treatment with glucocorticoids and calcineurin inhibitors could be reduced over 36 months, especially in patients with initial response.
Conclusion
Rituximab facilitates achievement of initial and long-term response in most adult patients with difficult-to-treat primary podocytopathies. Maintenance treatment with rituximab further increases long-term relapse-free survival over three years. Non-response to initial rituximab treatment is associated with poor renal prognosis.
Figure 1. Three-year relapse-free survival in rituximab-responders
Kaplan-Meier plots comparing the three-year relapse-free survival in rituximab-responders in the total cohort (panel A) and subgroup comparison with maintenance (red line) versus without maintenance (blue line) treatment with rituximab (panel B).