Cyclosporine versus mycophenolate mofetil for remission maintenance of severe steroid-dependent nephrotic syndrome after a single infusion of rituximab

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The efficacy of rituximab (RTX) as the sole therapy for preventing relapses of nephrotic syndrome (NS) is transient in most patients; therefore, the optimal therapy required for maintaining a successful response to a biological agent remains a challenge. We conducted a prospective study to compare the efficacy of cyclosporine (CsA) with that of mycophenolate mofetil (MMF) as maintenance therapy after a single infusion of RTX. Despite the mean number of relapses before RTX treatment being significantly lower in the MMF group than in the CsA group, the rate of sustained remission was significantly higher in the CsA group than in the MMF group. Our study also showed that a single infusion of RTX allowed a decrease in both CsA dose and NS relapse rate; therefore, it may be effective for preventing the progression of CsA nephrotoxicity. We recommend the early initiation of RTX treatment before increasing the dose of CsA in patients with secondary CsA-resistant /severe steroid-dependent NS to avoid the development of chronic nephrotoxicity.