Immune drug doesn't help kids with hard-to-treat kidney disorder

Highlights

• Children with a particular kidney immune disorder that is unresponsive to standard treatments do not benefit from the immune drug rituximab.
• Additional studies are needed to fully understand the disease and to develop effective therapies for hard-to-treat cases.

Washington, DC (May 10, 2012) — The drug rituximab, an antibody that targets the immune system and is often used to treat immune disorders such as lymphoma and arthritis, has recently emerged as a potential treatment for a childhood kidney disorder known as idiopathic nephrotic syndrome (INS). While the cause of INS is not fully known, it is believed to be an immune disorder. Unfortunately, rituximab does not appear to benefit children who have INS that is resistant to standard treatments, according to a study appearing in an upcoming issue of new study in the Journal of the American Society of Nephrology (JASN).

INS has an estimated incidence of two to seven cases per 100,000 children and a prevalence of nearly 16 cases per 100,000. Children with the disease excrete large amounts of protein in their urine and exhibit other signs of kidney damage. Gian Marco Ghiggeri, MD (IRCCS Giannina Gaslini Children Hospital, in Genoa, Italy) and his colleagues recently reported that rituximab can successfully lower protein excretion in children with INS that responds to standard treatments consisting of steroids and immunosuppressants called calcineurin inhibitors. Therefore, rituxmab may allow such patients to discontinue these potentially toxic medications.

A few anecdotal cases and small studies also suggest that rituximab may benefit children with INS that is unresponsive to standard treatments. To test this more rigorously, Ghiggeri and his team conducted the first randomized controlled trial of rituximab in 31 children with INS that did not respond to steroids and calcineurin inhibitors. All children in the study continued taking steroids and calcineurin inhibitors at the doses they took before they enrolled. Half of the patients also received two doses of rituximab.

After three months of treatment, rituximab did not reduce protein excretion in the urine.

By identifying which patients benefit from rituximab and which do not, "our work represents a step forward on the road to treating nephrotic syndrome in children," said Dr. Ghiggeri. However, the negative results of this latest study suggest that researchers and clinicians need a much better understanding of INS to develop effective therapies against cases that are resistant to standard treatment.

Study co-authors include Alberto Magnasco, Corrado Murtas (IRCCS Giannina Gaslini Children Hospital, in Genoa, Italy); Pietro Ravani (University of Calgary, in Alberta, Canada); Alberto Edefonti, Luciana Ghio, Mirco Belingheri, (Ospedale Maggiore Policlinico, in Milan, Italy); Luisa Murer, Elisa Benetti (Azienda Ospedaliera-University of Padova, in Padova, Italy); Giovanni Messina (Ospedale Giovanni XXIII, in Bari, Italy); Laura Massella (IRCCS Bambin Gesù Children Hospital, in Rome, Italy); Maria Gabriella Porcellini (Regina Margherita Children Hospital, in Turin, Italy); Michela Montagna, Mario Regazzi (Foundation IRCCS Policlinico San Matteo, in Pavia, Italy); and Francesco Scolari (Ospedale di Montichiari, in Brescia, Italy).

Disclosures: The study was supported by the Renal Child Foundation (Genoa, Italy) and La Fondazione La Nuova Speranza (Milan, Italy).

The article, entitled "Rituximab in Children with Resistant Idiopathic Nephrotic Syndrome," will appear online at http://jasn.asnjournals.org/ on May 10, 2012, doi: 10.1681/ASN.2011080775.

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