The Efficacy of Rituximab in Treatment of Childhood Steroid Resistant and Steroid Dependent Nephrotic Syndrome: A Systematic Review and Meta-Analysis

Corticosteroid resistant and dependent nephrotic syndrome in childrenis a challenge and there are some difficulties in treating such patients.we reviewed the current studies that evaluated therapeutic role of arelatively new immunosuppressive drug “rituximab” in reducingproteinuria and reduction of relapse rate in less than 16 year oldpatients with non-responsive or steroid dependent nephrotic syndrome.we searched medline, embase, web of science and cochrane librarywith appropriate keywords and conducted the complete remission,relapse rate and the mean number of relapses 12 month after therapy onmeta-analysis. we put the data on two different subgroups; steroidresistant nephrotic syndrome and steroid dependent or frequent relapsernephrotic syndrome. in steroid resistant nephrotic syndrome children,the complete remission was 0.27 (0.2- 0.34). in steroid dependentnephrotic syndrome patients, the overall standard mean differences ofmean number of relapses 12 mo after treatment in pooled four studies(56 cases) was 2.63 (2.03, 3.24). in these dependent patients, the dataon relapse rate after treatment pooled on 6 studies (162 cases) and yieldto the rate of 0.42 (0.15, 0.69) with the range of 0.09 to 0.83.in conclusion, rituximab is a reasonable therapy for steroid dependentand steroid resistant nephrotic syndrome children. in view of paucityof randomized data, we suggest to perform newer controlledmulticenter studies.