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Efficacy and Safety of Rituximab in Children With Difficult-To-Treat Nephrotic Syndrome; a Systematic Review Publisher



Azarfar A1 ; Ravanshad Y2, 3 ; Mehradmajd H2 ; Aval SB4 ; Nastarani S1 ; Emadzadeh M2 ; Khazaei MR5 ; Fazel M6 ; Azimi B1
Authors
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Authors Affiliations
  1. 1. Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
  2. 2. Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
  3. 3. Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
  4. 4. Department of Acupuncture, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  5. 5. Department of Pediatrics, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran
  6. 6. Valiasr Hospital, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Renal Injury Prevention Published:2018


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. © 2018 The Author(s).