Vol. 7, Issue 1, Part A (2025)

Introduction: Steroids are the cornerstone treatment for Minimal Change Disease (MCD); however approximately 25% of patients experience frequent relapses, and 30% become steroid-dependent, leading to significant toxicity. Rituximab has been increasingly used, although optimal dosing, maintenance strategies, and the best approach to steroid tapering remain unclear.
Methods: A retrospective cohort study was conducted on adult patients with steroid-dependent or frequently relapsing MCD treated with rituximab at a tertiary hospital from 2015 to 2023. Patients with concurrent glomerular diseases or <6 months of follow-up were excluded. We assessed rituximab’s efficacy, dosing regimens and its potential role in reducing steroid exposure.
Results: Thirteen patients (62.2% male, mean age at rituximab initiation of 41.4±16.9 years) were included, with a median follow-up of 24.0 [18.5 – 44.0] months. Seven patients received standard rituximab doses, while six received lower doses. Six patients did not receive rituximab maintenance. Eleven (84.6%) patients remained relapse-free, for a mean of 23.7±11.4 months. Of those on rituximab maintenance, none relapsed, while four of the six patients without rituximab maintenance remained relapse-free. The other 2 relapsed after a mean of 27.5±0.7 months, subsequent initiating rituximab maintenance. Ten patients discontinued steroids within a median of 5.3 [3.0- 10.5] months post-rituximab, achieving a mean steroid-free period of 19.5±14.4 months.
Conclusion: Rituximab is effective and safe for steroid-dependent or frequently relapsing MCD. Lower-dose regimens offer a favorable risk-benefit profile. Individualized maintenance therapy and accelerated steroid tapering allowed by rituximab reduce steroid-related toxicity and long-term complications.