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

Webb, H; Jaureguiberry, G; Dufek, S; Tullus, K; Bockenhauer, D; (2016) Cyclophosphamide and rituximab in frequently relapsing/steroid-dependent nephrotic syndrome. Pediatric Nephrology , 31 (4) pp. 589-594. 10.1007/s00467-015-3245-9. Green open access

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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.

Type: Article
Title: Cyclophosphamide and rituximab in frequently relapsing/steroid-dependent nephrotic syndrome
Location: Germany
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s00467-015-3245-9
Publisher version: http://dx.doi.org/10.1007/s00467-015-3245-9
Language: English
Additional information: The final publication is available at Springer via http://dx.doi.org/10.1007/s00467-015-3245-9.
Keywords: Cyclophosphamide, Frequently relapsing nephrotic syndrome, Outcome, Rituximab, Steroid dependent nephrotic syndrome
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/1483441
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