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Background <p>Refractory nephrotic syndrome (RNS) in children remains difficult to manage, particularly in patients who fail to maintain sustained remission after rituximab (RTX). Optimal follow-up treatment strategies after RTX failure remain unclear. This study aimed to evaluate the efficacy of different follow-up treatment strategies after RTX failure.</p> Methods <p>This retrospective study included children with RNS who failed to maintain sustained remission after a single course of RTX. According to subsequent treatment, patients were divided into three groups: anti-CD20-free maintenance therapy (ACF), RTX retreatment (RTX-R), and obinutuzumab treatment (OBZ). Patients in the ACF group received corticosteroids and/or other immunosuppressants without additional anti-CD20 biologics, whereas those in the RTX-R and OBZ groups received RTX or OBZ therapy respectively.</p> Results <p>Twenty-eight children were included: 10 in the ACF group, 8 in the RTX-R group, and 10 in the OBZ group. At 6&#xa0;months, the OBZ group demonstrated significantly higher relapse-free survival compared to both the RTX-R group (100% vs. 37.5%, <i>P</i> &lt; 0.01) and the ACF group (100% vs. 30%, <i>P</i> &lt; 0.01), with no difference between the RTX and ACF groups. At 52&#xa0;weeks, relapse-free survival remained highest in the OBZ group (80.0%), compared with 25.0% in the RTX-R group and 30.0% in the ACF group. OBZ induced sustained peripheral B-cell depletion, with B cells remaining undetectable throughout the scheduled 6-month follow-up. No serious adverse effects were observed in three groups.</p> Conclusion <p>Obinutuzumab may be an effective and safe follow-up option for children with RNS who fail to maintain sustained remission after RTX.</p> Graphical Abstract <p> A higher resolution version of the Graphical abstract is available as <InternalRef RefID="MOESM1">Supplementary information</InternalRef></p>

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Evaluation of the comparative efficacy and safety of obinutuzumab and other follow-up strategies after rituximab failure in refractory nephrotic syndrome

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Haoyu Zha,
  • Chaoying Chen,
  • Juan Tu,
  • Ling Wan

摘要

Background

Refractory nephrotic syndrome (RNS) in children remains difficult to manage, particularly in patients who fail to maintain sustained remission after rituximab (RTX). Optimal follow-up treatment strategies after RTX failure remain unclear. This study aimed to evaluate the efficacy of different follow-up treatment strategies after RTX failure.

Methods

This retrospective study included children with RNS who failed to maintain sustained remission after a single course of RTX. According to subsequent treatment, patients were divided into three groups: anti-CD20-free maintenance therapy (ACF), RTX retreatment (RTX-R), and obinutuzumab treatment (OBZ). Patients in the ACF group received corticosteroids and/or other immunosuppressants without additional anti-CD20 biologics, whereas those in the RTX-R and OBZ groups received RTX or OBZ therapy respectively.

Results

Twenty-eight children were included: 10 in the ACF group, 8 in the RTX-R group, and 10 in the OBZ group. At 6 months, the OBZ group demonstrated significantly higher relapse-free survival compared to both the RTX-R group (100% vs. 37.5%, P < 0.01) and the ACF group (100% vs. 30%, P < 0.01), with no difference between the RTX and ACF groups. At 52 weeks, relapse-free survival remained highest in the OBZ group (80.0%), compared with 25.0% in the RTX-R group and 30.0% in the ACF group. OBZ induced sustained peripheral B-cell depletion, with B cells remaining undetectable throughout the scheduled 6-month follow-up. No serious adverse effects were observed in three groups.

Conclusion

Obinutuzumab may be an effective and safe follow-up option for children with RNS who fail to maintain sustained remission after RTX.

Graphical Abstract

A higher resolution version of the Graphical abstract is available as Supplementary information