The efficacy and safety of half-dose glucocorticoids combined with rituximab versus high-dose glucocorticoids for initial treatment of minimal change disease: a single-center experience.

Background: Minimal change disease (MCD) is a podocytopathy more commonly seen in children, but it also accounts for 10%-25% of adult nephrotic syndrome. High-dose oral glucocorticoids were recommended for initial treatment of MCD. However, long-term use of systemic corticosteroids is associated with significant adverse events, such as steroid-induced diabetes and infections. The aim of this study was to investigate the clinical efficacy and safety of half-dose glucocorticoids combined with rituximab (RTX) for the initial treatment of MCD.

Methods: We recruited 74 patients with MCD confirmed by renal biopsy. Twenty patients were treated with RTX alone with 1000 mg at d1 and d15, 28 patients received half-dose prednisolone (0.5 mg/kg) per day combined with RTX with 1000 mg at d1, and 26 patients received high-dose prednisolone (1 mg/kg) per day. Treatment responses, including complete remission (CR) and partial remission (PR), and outcome adverse events such as steroid-induced diabetes and infections were compared among the three groups after 12 months of follow-up.

Results: At the 12-month follow-up, the CR rates were 50%, 96.4%, and 96.2% for the RTX group, half-dose prednisolone combined with RTX group, and high-dose prednisolone group, respectively. There was no statistical difference between the half-dose prednisolone combined with RTX group and high-dose prednisolone group on CR and PR and kidney function ( > 0.05). Compared with the high-dose prednisolone group, the half-dose prednisolone combined with RTX group had a reduced incidence of adverse events of steroid diabetes ( = 0.041), especially in patients older than 55 years of age.

Conclusion: The efficiency of half-dose prednisolone combined with RTX is not inferior to the recommended treatment regimen, and this regimen can effectively reduce the incidence of steroid-induced diabetes in patients with MCD. Moreover, we recommend a half-dose prednisolone combined with RTX treatment for elderly patients with MCD.