Clinical Study On The Efficacy And Safety Of Rituximab In The Treatment Of Children With Frequent Relapse/Steriod-dependent Nephrotic Syndrome

Objective:To explore the efficacy and safety of rituximab in the treatment of children with frequent relapse/steriod-dependent nephrotic syndrome.Methods:A total of 44 children with FRNS/SDNS diagnosed in the Pediatric Kidney Disease Specialty Group from the Second Hospital of Hebei Medical University from September 2017 to September 2019 were collected,of which 22 received hormonal or CNIs as the control group.On the basis of traditional treatment,RTX(375 mg/m~2/time,maximum 500 mg/time,once a week)should be treated after urine protein turns negative,and a second course of RTX can be given after B cell recovery(CD19+>5%),the dose is the same as the first course of treatment,for the RTX group,a total of 22 cases.Compare the recurrence frequency,hormone accumulation,and hormone-free duration at 6 and 12 months after treatment between the two groups.Glucocorticoids were stopped within 3 to 4 months after RTX treatment.Results:During a follow-up of 1 year,the continuous remission rate for6 months was 77.27%in the RTX group and 31.81%in the control group.There was a significant difference between the two groups(P=0.002).The annual recurrence rate was 54.54%in the RTX group,95.45%in the control group.There were significant differences between them(P=0.004).Compared with the control group,the urine protein continuous remission time in the RTX group was significantly longer(P=0),the cumulative amount of hormones was lower(P=0.01),and the duration of non-hormones was significantly longer(P=0).One case of pneumocystis pneumonia occurred in the RTX group,and no serious adverse event was found.There was no significant difference in the incidence of adverse events between the two groups.Conclusions:1.Rituximab has a significant effect in the treatment of children with frequently relaps/steriod-dependent nephrotic syndrone,which can improve the remission rate,reduce the annual relapse rate,reduce the amount of hormones,prolong the urine protein continuous remission time and hormone-free Maintain time.2.The incidence of adverse events after rituximab treatment in children with frequently relaps/steriod-dependent refractory nephrotic syndrome is low and mild.Most manifested as allergic-like reactions during infusion,and the incidence of serious adverse events was not high.