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Background <p>Rituximab-induced serum sickness (RISS) is a rare drug complication in patients with steroid-dependent nephrotic syndrome (SDNS).</p> Case–diagnosis/treatment <p>A 7-year-old boy with SDNS exhibited RISS recurrence 8 days after the third rituximab dose. At that time, the patient’s antirituximab antibody (ARA) level was extremely high at &gt; 5000&#xa0;ng/mg, and his serum rituximab drug level was undetectable at &lt; 0.2&#xa0;μg/mL. Further, the patient had an early relapse with a short B-cell depletion period after the third rituximab dose. To address ARA-mediated rituximab resistance, a single infusion of obinutuzumab at a dose of 300&#xa0;mg/m<sup>2</sup> was administered. The treatment led to an extended B-cell depletion period of &gt; 6 months and sustained disease remission for 15 months without significant adverse events such as hypogammaglobulinemia and neutropenia.</p> Conclusions <p>Low-dose obinutuzumab can be an effective and safe option for rituximab-resistant SDNS complicated by RISS and the development of ARA.</p>

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Low-dose obinutuzumab for steroid-dependent nephrotic syndrome complicated by recurrent rituximab-induced serum sickness and anti-rituximab antibodies

  • 期刊论文

  • 发表日期：

    2025年2月18日

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  • Shuichiro Fujinaga,
  • Kanako Saito,
  • Yoshitaka Watanabe,
  • Mayu Nakagawa,
  • Koji Sakuraya

摘要

Background

Rituximab-induced serum sickness (RISS) is a rare drug complication in patients with steroid-dependent nephrotic syndrome (SDNS).

Case–diagnosis/treatment

A 7-year-old boy with SDNS exhibited RISS recurrence 8 days after the third rituximab dose. At that time, the patient’s antirituximab antibody (ARA) level was extremely high at > 5000 ng/mg, and his serum rituximab drug level was undetectable at < 0.2 μg/mL. Further, the patient had an early relapse with a short B-cell depletion period after the third rituximab dose. To address ARA-mediated rituximab resistance, a single infusion of obinutuzumab at a dose of 300 mg/m2 was administered. The treatment led to an extended B-cell depletion period of > 6 months and sustained disease remission for 15 months without significant adverse events such as hypogammaglobulinemia and neutropenia.

Conclusions

Low-dose obinutuzumab can be an effective and safe option for rituximab-resistant SDNS complicated by RISS and the development of ARA.