Reducing reliance on corticosteroids: Renewed hope for adult-onset patients with relapsing nephrotic syndrome (Rituximab)

Medical Xpress / University of Osaka / JAMA ^ | Nov. 5, 2025 | Yoshitaka Isaka, et al

[ConservativeMind]

One monoclonal antibody, rituximab, can work wonders for the treatment of children with frequently relapsing nephrotic syndrome or steroid-dependent nephrotic syndrome. However, what about patients who developed nephrotic syndrome in adulthood?

As this drug is not yet approved for use in adult-onset patients, researchers wanted to highlight the profound benefits that rituximab has in adult-onset patients with these challenging conditions.

Nephrotic syndrome is a kidney disorder that causes the body to excrete too much protein in the urine. For adults with frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS), management can be particularly challenging.

The study, a randomized, double-blind clinical trial, reveals the effectiveness of rituximab for preventing relapses in adult-onset FRNS or SDNS.

The study involved 66 adult patients treated with either rituximab or a placebo.

"Rituximab is a monoclonal antibody that depletes B cells, which are key players in the immune system," explains Yoshitaka Isaka.

The results have sparked great excitement. At the 49-week follow-up, 87.4% of adult patients treated with rituximab remained relapse-free, compared with only 38.0% treated with placebo. This impressive rate difference implies that rituximab is highly effective for preventing relapses in adults with FRNS or SDNS.

Adding to this observation, the researchers found that among the patients who relapsed while initially being treated with placebo, none relapsed after switching to rituximab, and the time spent being relapse-free was longer in those who had rituximab throughout (49.0 weeks vs. 30.8 weeks with placebo).

The efficacy of rituximab at reducing relapses also came at very little cost, demonstrating the drug's impressive safety. Crucially, no severe drug-related side effects were seen with rituximab.

The study also highlighted the potential benefits of rituximab in reducing the need for corticosteroids, which are commonly used to manage nephrotic syndrome, but can have undesirable side effects.

[ConservativeMind]

Nephrotic syndrome in adults can be treated the same as for children, with similar benefits, however, it is not currently approved for adults and would need to be given off-label.

[ConservativeMind]

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[irishjuggler]

Corticosteroids are really bad news. I had a cortisone injection for some shoulder pain once, and it was like I was bouncing-off-walls-high-on-speed for the next hour. Never again if I can help it.