Persistent CD‐19 depletion by rituximab is cost‐effective in maintaining remission in calcineurin‐inhibitor dependent podocytopathy

Aim: A significant proportion of patients with minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are either steroid dependent (SD) or resistant (SR), requiring long-term calcineurin inhibitors (CNIs) use. Rituximab has more favourable safety profile. The present study was undertaken to evaluate the efficacy and safety of rituximab in CNI dependent patients.Methods: This was a prospective observational study conducted from July 2014 to February 2018. SD-NS or SR-NS (biopsy proven MCD/FSGS), who were CNI dependent were enrolled. Mean age at enrolment was 22.77±7.45 years. All patients received rituximab at a dose of 375 mg/m2 at entry in the study. CD-19 levels were monitored monthly and patients having CD-19 levels >5/μL and/or >1% received additional low-dose (100 mg) of rituximab.Results: A total of 24 patients were followed up for 12 months. At the end of 6 and 12 months, 87.5 and 79.16% of the patients achieved remission, respectively. Eight (33.33%) patients developed relapse. The mean dose of rituximab in the first year was 791 mg. The average cost of rituximab in the first year was 487.17$. Rituximab was well- tolerated, with mild infusion reactions, respiratory tract infection and oral candidiasis in 5 (20.83%), 5 (20.83%) and 1 (4.17%) patient, respectively.Conclusions: CD-19 targeted rituximab is a safe and cost-effective agent in remission maintenance in adults with CNI dependent. Over three-fourths of the patients with CNI dependent podocytopathy maintain clinical remission with CD-19 targeted rituximab therapy