eISSN: 2345-2781  
J Renal Inj Prev. 2018;7(4):307-313.
doi: 10.15171/jrip.2018.67

Review

Efficacy and Safety of rituximab in children with difficult-to-treat nephrotic syndrome; a systematic review

Anoush Azarfar 1, Yalda Ravanshad 2,3 * , Hassan Mehrad-Majd 2, Shapour Badie Aval 4, Sanaz Nastarani 1, Maryam Emadzadeh 2, Mahmood Reza Khazaei 5, Mojtaba Fazel 6, Behnam Azimi 1

1 Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
2 Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
4 Department of Acupuncture, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
5 Department of Pediatrics, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran
6 Valiasr Hospital, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
*Corresponding author: Yalda Ravanshad, Email: Email: yalda.ravanshad@gmail.com

Abstract

To date, several studies have been done on efficacy and safety of drugs in children with refractory nephrotic syndrome (NS). Rituximab (RTX) might be a hopeful treatment for this syndrome. However, the long-term effects and cost-effectiveness of RTX treatment were not fully assessed. This study aims to do a systematic review about the efficacy and safety of RTX in children with difficult-to-treat NS. For this research, an electronic literature search was conducted to identify appropriate investigations. The search term was ("nephrotic syndrome" or "minimal change disease" or "focal segmental glomerulosclerosis" or membranous) and (‘‘rituximab’’ or ‘‘CD20’’). We included all randomized trials and observational studies about using RTX in children with difficult-to-treat NS. Two independent reviewers extracted data from the papers according to the selection criteria. Eligible studies were included in this systematic review. The literature search and reference mining yielded 919 potential relevant papers. We removed 340 articles because of duplication. We also excluded 513 papers after reviewing the titles and abstracts. Finally, 17 studies were included in the systematic review. Efficacy of RTX in children with NS in most of the studies was assessed with relapse-free survival or complete remission rates. Acknowledging the limitations of the study due to the size and nature of the studies included, our systematic review shows that RTX was effective in the treatment of refractory NS in children, and it could reduce the use of steroid and immunosuppressants. However, further large randomized trials are suggested.

Implication for health policy/practice/research/medical education:

RTX was effective in the treatment of refractory NS in children, and it could reduce the use of steroid and immunosuppressants. However, further large randomized trials are suggested.

Please cite this paper as: Azarfar A, Ravanshad Y, Mehrad-Majd H, Badiei Aval S, Nastarani S, Emadzadeh M, et al. Efficacy and Safety of rituximab in children with difficult-to-treat nephrotic syndrome; a systematic review. J Renal Inj Prev. 2018;7(4):307- 313. doi: 10.15171/jrip.2018.67.

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