Clinical evaluation of low-dose rituximab and cyclophosphamide combined with prednisone in the treatment of patients with refractory nephrotic syndrome
Chen Yong
Wang Yaqian
Ning Xiaoyuan
Luo Dongping
Ru Yanhai
Xu Jiayun
Abstract：Objective To compare the efficacy and safety of low-dose rituximab(LD-RTX)and cyclophosphamide(CTX)com-bined with hormones respectively in the treatment of refractory nephrotic syndrome.Methods A total of 84 patients with refractory nephrotic syndrome admitted to the First Affiliated Hospital of Henan University of Science and Technology from March 2023 to Octo-ber 2024 were selected and randomly divided into the LD-RTX group(42 cases,treated with RTX 200 mg·(m2)-1 repeated infusion plus prednisone)and the CTX group(42 cases,treated with CTX plus prednisone)according to a random number table method.The clinical remission rates,renal function indicators,immune function indicators and safety were compared between the two groups.Results Af-ter 3 months of treatment,the total remission rate was 47.62%(20/42)in the LD-RTX group and 28.57%(12/42)in the CTX group,with no statistically significant difference between the two groups(χ2=3.231,P=0.072).After 6 months of treatment,the complete remission rate of the LD-RTX group(40.48%(17/42))was higher than that of the CTX group(19.05%(8/42))(χ2=4.613,P=0.032),and the overall remission rate of the LD-RTX group(90.48%(38/42))was higher than that of the CTX group(69.05%(29/42))(χ2=5.974,P=0.015).After treatment,the quantitative values of 24-hour urinary protein,serum creatinine and urea nitrogen in the LD-RTX group((0.86±0.31)g,(67.52±9.37)μmol·L-1,(5.43±0.72)mmol·L-1)were all lower than those in the CTX group((1.17±0.40)g,(84.15±9.63)μmol·L-1,(6.92±0.84)mmol·L-1)(t=3.970,8.021,8.728,all P<0.05).Additionally,the CD4+/CD8+ratio in the LD-RTX group(1.34±0.26)was higher than that in the CTX group(1.19±0.17),while the CD19+B cell count in the LD-RTX group((21.36±5.47)cells·μL-1)was lower than that in the CTX group((34.82±9.21)cells·μL-1)(t=3.129,8.143,both P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(χ2=0.283,P=0.595).Conclusion The efficacy of LD-RTX combined with hormones in the treatment of patients with refractory nephrotic syndrome is superior to that of CTX combined with hormones,and the safety is comparable.The CTX regimen is more economical and can be selected clinically as needed.
Keywords：Refractory nephrotic syndromeRituximabCyclophosphamideGlucocorticoidsTherapeutic effect
Publication Date：2025-08-25
Online Publishing Date：2025-09-01(First online date of this platform, not the publication date of the document)
Pages：4( 938-941 )