SAT-469 EFFECT OF RITUXIMAB ON GROWTH AND BODY MASS INDEX IN CHILDHOOD STEROID DEPENDENT NEPHROTIC SYNDROME: A RETROSPECTIVE MULTI-CENTER REVIEW

Abstract

Data on anthropometric outcomes post rituximab among steroid dependent / frequently relapsing nephrotic syndromes (FRNS/SDNS) is scarce. Aim of this study was to analyze anthropometric outcome among a multicenter cohort of FRNS/SDNS post rituximab therapy. Retrospective review of case records was undertaken to identify FRNS/SDNS who received rituximab (May 2012 to June 2018). Number of relapses, change in steroid threshold and anthropometrical parameters (Weight, Height and Body Mass Index SDS) post rituximab were assessed. 102 children with SDNS (male: 64%; n = 64) received a total of 211 rituximab infusions (Total 111 cycles). Median age was 7 (IQR: 4.3 to 9.6) years and median follow up after completing an individual cycle was 2.1 (IQR: 1.3 to 2.8) years. Changes in anthropometric parameters were analyzed for children ≤ 12 years (n=92). A significant drop in BMI SDS (0.97 ± 1.98 to 0.25 ± 1.5, p= 0.007) and improvement in height SDS (-0.67 ± 1.84 to -0.186 ± 1.42, p = 0.047) was noted. Obesity (38% to 20%, p =0.003) and short stature (11% to 3% p =0.02) showed a significant drop post rituximab. On multivariate analysis apart from duration of follow up no other variables (age, sex, dose of steroid at start or end) showed any significant association with anthropometric improvement. Sustained remission was seen in 52 children (median follow-up of 24.5; IQR: 14 ±31 months) whereas 50 children relapsed at a median interval of 8 (IQR: 6 to 12.5) months. CD19 target count of <1% was achieved in all and CD 19 normalized (>5%) by 7 (IQR: 5 to 8) months with only 4 children relapsing with CD19 cell count <5%. Despite similar follow-up period; 25% of MCNS (n=17) were off all immunosuppressant in contrast to none with FSGS, p =0.05. In our cohort of difficult nephrotic syndrome use of rituximb resulted in significant anthropometric benefits.