Minimal change nephrotic syndrome (MCNS) usually responds to
steroids but frequently relapses, requiring additional treatment with
immunosuppressive agents.
Rituximab is a chimeric murine/human monoclonal
immunoglobulin G1 antibody that targets CD20, a B-cell differentiation marker. B-cell recovery begins at approximately 6 months following the completion of treatment.
Rituximab has a beneficial effect, with the sustained remission or reduction of
proteinuria in patients with
steroid-dependent MCNS. Relapses are thought to be associated with an increase in CD19 cells. The mean serum half-life of
rituximab was reported to be 10-15 days in patients with
steroid-dependent nephrotic syndrome. Only infusion reactions, such as
rash and
chills, occurred after single-dose
rituximab infusion and can be managed by pre-medication or infusion rate adjustments. Even though severe adverse effects of
rituximab are not expected, physicians must be aware of potentially life-threatening adverse effects. Controlled randomized trials that include adult patients with
steroid-dependent or
steroid-resistant MCNS are required to prove the efficacy and safety of
rituximab and to evaluate the cost-effectiveness of
rituximab treatment.