The Role of Rituximab in Primary Focal Segmental Glomerulosc
Primary Focal Segmental Glomerulosclerosis (FSGS) is a rare, likely immune-mediated disease. Rituximab (RTX) may play a role in management. Thirty-one patients were followed for at least 12 months; further follow-up (median 17 months, IQR 15-33.5) was available for 11. At first RTX administration, median creatinine and 24h proteinuria were 1.17mg/dl (IQR 0.83-1.62) and 5.2g (IQR 3.3-8.81), respectively. Response rate at 3-6-12 months was 39-52-42%. During the first 12 months, creatinine remained stable while proteinuria and serum albumin improved, with an increase in the proportion of patients tapering other immunosuppressants. Six patients were retreated with RTX within 12 months, either for proteinuria increase or refractory disease; only the two responders to the first RTX course experienced a further response. At univariate analysis, 6-month response was more frequent in steroid-dependent patients (OR 7.7[95%CI 1.16-52.17]) and those with proteinuria<5g/24h (OR 8.25[1.45-46.86]). RTX may be an option in primary FSGS, especially in steroid-dependent patients, with 24h proteinuria<5g and previously responders to RTX. Optimal long-term management for responders is unclear, with some patients experiencing sustained remission and others requiring RTX retreatment, either preemptive or following rising proteinuria.