Top

Pediatric Nephrology

Published in:

01-08-2014 | Brief Report

Development of antirituximab antibodies in children with nephrotic syndrome

Authors: Yo Han Ahn, Hee Gyung Kang, Jiwon M. Lee, Hyun Jin Choi, Il-Soo Ha, Hae Il Cheong

Published in: Pediatric Nephrology | Issue 8/2014

Abstract

Background

Rituximab is actively used as a rescue therapy for nephrotic syndrome (NS). The development of antidrug antibodies, including antirituximab antibodies (ARA) and human antichimeric antibodies (HACA), is reported with rituximab treatment in various diseases. Here we report two pediatric patients with NS who developed ARA.

Case diagnosis and treatment

Rituximab was given as a rescue therapy for two patients with steroid-dependent NS. Both patients had been treated orally with glucocorticosteroid, methylprednisolone, and calcineurin inhibitors but experienced frequent relapses. With rituximab treatment, the patients remained in remission for several months. After the B-cell count recovered, the patients received a second course of rituximab administration and experienced a hypersensitivity reaction during drug infusion. CD19 cell counts rose despite treatment with rituximab. ARA titers were monitored before and after rituximab treatment, and the development of ARA after the second course of rituximab administration was confirmed.

Conclusions

We report the development of HACA in two patients with NS who did not achieve B-cell depletion after repeated administration of rituximab. This report suggests that additional studies are needed to determine the incidence of ARA in patients with NS, and its clinical significance.

Ravani P, Magnasco A, Edefonti A, Murer L, Rossi R, Ghio L, Benetti E, Scozzola F, Pasini A, Dallera N, Sica F, Belingheri M, Scolari F, Ghiggeri GM (2011) Short-term effects of rituximab in children with steroid- and calcineurin-dependent nephrotic syndrome: a randomized controlled trial. Clin J Am Soc Nephrol 6:1308–1315PubMedCentralPubMedCrossRef

Guigonis V, Dallocchio A, Baudouin V, Dehennault M, Hachon-Le Camus C, Afanetti M, Groothoff J, Llanas B, Niaudet P, Nivet H, Raynaud N, Taque S, Ronco P, Bouissou F (2008) Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases. Pediatr Nephrol 23:1269–1279PubMedCrossRef

Tellier S, Brochard K, Garnier A, Bandin F, Llanas B, Guigonis V, Cailliez M, Pietrement C, Dunand O, Nathanson S, Bertholet-Thomas A, Ichay L, Decramer S (2013) Long-term outcome of children treated with rituximab for idiopathic nephrotic syndrome. Pediatr Nephrol 28:911–918PubMedCrossRef

Kemper MJ, Gellermann J, Habbig S, Krmar RT, Dittrich K, Jungraithmayr T, Pape L, Patzer L, Billing H, Weber L, Pohl M, Rosenthal K, Rosahl A, Mueller-Wiefel DE, Dotsch J (2012) Long-term follow-up after rituximab for steroid-dependent idiopathic nephrotic syndrome. Nephrol Dial Transplant 27:1910–1915PubMedCrossRef

Cornec D, Tempescul A, Querellou S, Hutin P, Pers JO, Jamin C, Bendaoud B, Berthou C, Renaudineau Y, Youinou P (2012) Identification of patients with indolent B cell lymphoma sensitive to rituximab monotherapy. Ann Hematol 91:715–721PubMedCrossRef

Igarashi T, Kobayashi Y, Ogura M, Kinoshita T, Ohtsu T, Sasaki Y, Morishima Y, Murate T, Kasai M, Uike N, Taniwaki M, Kano Y, Ohnishi K, Matsuno Y, Nakamura S, Mori S, Ohashi Y, Tobinai K, I-CBSGi J (2002) Factors affecting toxicity, response and progression-free survival in relapsed patients with indolent B-cell lymphoma and mantle cell lymphoma treated with rituximab: a Japanese phase II study. Ann Oncol 13:928–943PubMedCrossRef

Keystone E, Fleischmann R, Emery P, Furst DE, van Vollenhoven R, Bathon J, Dougados M, Baldassare A, Ferraccioli G, Chubick A, Udell J, Cravets MW, Agarwal S, Cooper S, Magrini F (2007) Safety and efficacy of additional courses of rituximab in patients with active rheumatoid arthritis: an open-label extension analysis. Arthritis Rheum 56:3896–3908PubMedCrossRef

Looney RJ, Anolik JH, Campbell D, Felgar RE, Young F, Arend LJ, Sloand JA, Rosenblatt J, Sanz I (2004) B cell depletion as a novel treatment for systemic lupus erythematosus: a phase I/II dose-escalation trial of rituximab. Arthritis Rheum 50:2580–2589PubMedCrossRef

Fervenza FC, Cosio FG, Erickson SB, Specks U, Herzenberg AM, Dillon JJ, Leung N, Cohen IM, Wochos DN, Bergstralh E, Hladunewich M, Cattran DC (2008) Rituximab treatment of idiopathic membranous nephropathy. Kidney Int 73:117–125PubMedCrossRef

10.

Davis TA, Grillo-Lopez AJ, White CA, McLaughlin P, Czuczman MS, Link BK, Maloney DG, Weaver RL, Rosenberg J, Levy R (2000) Rituximab anti-CD20 monoclonal antibody therapy in non-Hodgkin's lymphoma: safety and efficacy of re-treatment. J Clin Oncol 18:3135–3143PubMed

11.

Albert D, Dunham J, Khan S, Stansberry J, Kolasinski S, Tsai D, Pullman-Mooar S, Barnack F, Striebich C, Looney RJ, Prak ET, Kimberly R, Zhang Y, Eisenberg R (2008) Variability in the biological response to anti-CD20 B cell depletion in systemic lupus erythaematosus. Ann Rheum Dis 67:1724–1731PubMedCrossRef

12.

van Schouwenburg PA, Rispens T, Wolbink GJ (2013) Immunogenicity of anti-TNF biologic therapies for rheumatoid arthritis. Nat Rev Rheumatol 9:164–172PubMedCrossRef

13.

Lunardon L, Payne AS (2012) Inhibitory human antichimeric antibodies to rituximab in a patient with pemphigus. J Allergy Clin Immunol 130:800–803PubMedCentralPubMedCrossRef

14.

Tahir H, Rohrer J, Bhatia A, Wegener WA, Isenberg DA (2005) Humanized anti-CD20 monoclonal antibody in the treatment of severe resistant systemic lupus erythematosus in a patient with antibodies against rituximab. Rheumatology (Oxford) 44:561–562CrossRef

15.

Goto S, Goto H, Tanoshima R, Kato H, Takahashi H, Sekiguchi O, Kai S (2009) Serum sickness with an elevated level of human anti-chimeric antibody following treatment with rituximab in a child with chronic immune thrombocytopenic purpura. Int J Hematol 89:305–309PubMedCrossRef

Title: Development of antirituximab antibodies in children with nephrotic syndrome
Authors: Yo Han Ahn
Hee Gyung Kang
Jiwon M. Lee
Hyun Jin Choi
Il-Soo Ha
Hae Il Cheong
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 8/2014
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-014-2794-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Development of antirituximab antibodies in children with nephrotic syndrome

Abstract

Background

Case diagnosis and treatment

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case diagnosis and treatment

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2014

CD80 and suPAR in patients with minimal change disease and focal segmental glomerulosclerosis: diagnostic and pathogenic significance

An unusual cause of abdominal ascites and acute kidney injury: Questions

Malcolm A. Holliday, M.D, January 12, 1924–March 26, 2014

Optimizing peritoneal dialysis prescription for volume control: the importance of varying dwell time and dwell volume

Solid organ transplantation following end-organ failure in recipients of hematopoietic stem cell transplantation in children

Urinary concentration: different ways to open and close the tap