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Pediatric Nephrology

Published in:

01-04-2016 | Original Article

Cyclophosphamide and rituximab in frequently relapsing/steroid-dependent nephrotic syndrome

Authors: Hazel Webb, Graciana Jaureguiberry, Stephanie Dufek, Kjell Tullus, Detlef Bockenhauer

Published in: Pediatric Nephrology | Issue 4/2016

Abstract

Background

Steroid-sensitive nephrotic syndrome is the most common form of nephrotic syndrome in childhood, defined by the response to treatment with glucocorticoids with consequent remission. While most children eventually experience spontaneous resolution of the disease, some have a difficult course with frequent relapses or steroid dependence nephrotic syndrome (FRSDNS). The consequent steroid toxicity often prompts administration of other immunosuppressive drugs, traditionally cyclophosphamide. Recently, rituximab has been reported as effective in this disorder, but long-term experience is lacking.

Methods

Retrospective note review of all children with FRSDNS treated with a first course of cyclophosphamide and/or rituximab in our center between December 2006 and April 2015. We reviewed time to first relapse after treatment, co-medications, and side effects.

Results

A total of 102 children were treated with cyclophosphamide (79) and/or rituximab (42). Of these, 34 received cyclophosphamide prior to rituximab. Median time to first relapse was 7 months after cyclophosphamide and 14 months after rituximab. Documented side effects of cyclophosphamide included neutropenia, hair loss, and hemorrhagic cystitis (1). Rituximab was associated with an allergic reaction at infusion in two patients.

Conclusions

Rituximab was used in children with the most difficult to treat FRSDNS, yet was associated with longer remission time and less side effects than cyclophosphamide. A randomized controlled trial is needed to directly compare these drugs.

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Title: Cyclophosphamide and rituximab in frequently relapsing/steroid-dependent nephrotic syndrome
Authors: Hazel Webb
Graciana Jaureguiberry
Stephanie Dufek
Kjell Tullus
Detlef Bockenhauer
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 4/2016
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-015-3245-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cyclophosphamide and rituximab in frequently relapsing/steroid-dependent nephrotic syndrome

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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