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Primary forms of these diseases are treated with various regimes of immunosuppression. Frequently relapsing or glucocorticoid-dependent courses remain challenging. Here, a B-cell-depleting strategy with rituximab represents a salvage option although data are sparse in the adult population. In particular, there is limited evidence on the efficacy of restoring remission after initial successful treatment with rituximab and whether patients benefit from an individualized, relapse-based approach. We identified 13 patients who received multiple therapies with rituximab from the FOrMe-registry (NCT03949972), a nationwide registry for MCD and FSGS in Germany, or from the University Hospital of Cologne. Disease status, changes in serum creatinine, proteinuria, and time to relapse were evaluated. Relapse-free survival was compared to the patients\u2019 previous therapy regimens. Through all treatment cycles, an improvement of disease activity was shown leading to a complete remission in 72% and partial remission in 26% after 3 (<jats:inline-formula><jats:alternatives><jats:tex-math>$$p&lt;$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mrow>\n                    <mml:mi>p<\/mml:mi>\n                    <mml:mo>&lt;<\/mml:mo>\n                  <\/mml:mrow>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula>0.001) and 6 months (<jats:inline-formula><jats:alternatives><jats:tex-math>$$p&lt;$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mrow>\n                    <mml:mi>p<\/mml:mi>\n                    <mml:mo>&lt;<\/mml:mo>\n                  <\/mml:mrow>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula>0.001). Relapse-free survival increased from 4.5 months (95%-CI 3\u201310 months) to 21 months (95%-CI 16\u201332 months) (<jats:inline-formula><jats:alternatives><jats:tex-math>$$p&lt;$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mrow>\n                    <mml:mi>p<\/mml:mi>\n                    <mml:mo>&lt;<\/mml:mo>\n                  <\/mml:mrow>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula>0.001) compared to previous immunosuppression regimens with no loss in estimated glomerular filtration over time (<jats:italic>p<\/jats:italic> = 0.53). Compared to continuous B-cell depletion, an individualized relapse-based approach led to a reduced rituximab exposure and significant cost savings. Relapse-based administration of rituximab in patients with MCD\/FSGS with an initial good clinical response did not result in a decreased efficacy at a median follow-up duration of 110 months. Thus, reinduction therapies may provide an alternative to continuous B-cell-depletion and reduce the long-term side effects of continuous immunosuppression.<\/jats:p>","DOI":"10.1038\/s41598-023-32576-7","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T12:03:09Z","timestamp":1682683389000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Repetitive administration of rituximab can achieve and maintain clinical remission in patients with MCD or FSGS"],"prefix":"10.1038","volume":"13","author":[{"given":"Thomas","family":"Osterholt","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Polina","family":"Todorova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas","family":"K\u00fchne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rasmus","family":"Ehren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lutz Thorsten","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franziska","family":"Grundmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Benzing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul Thomas","family":"Brinkk\u00f6tter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linus Alexander","family":"V\u00f6lker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"key":"32576_CR1","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1093\/ndt\/gfq665","volume":"26","author":"A McGrogan","year":"2011","unstructured":"McGrogan, A., Franssen, C. F. M. & de Vries, C. S. The incidence of primary glomerulonephritis worldwide: A systematic review of the literature. Nephrol. Dial. Transpl. Offi. Publ. Eur. Dial. Transpl. Assoc. Euro. Renal Association 26, 414\u2013430. https:\/\/doi.org\/10.1093\/ndt\/gfq665 (2011).","journal-title":"Nephrol. Dial. Transpl. Offi. Publ. Eur. Dial. Transpl. Assoc. Euro. Renal Association"},{"key":"32576_CR2","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1038\/s41581-021-00427-1","volume":"17","author":"AS de Vriese","year":"2021","unstructured":"de Vriese, A. S., Wetzels, J. F., Glassock, R. J., Sethi, S. & Fervenza, F. C. Therapeutic trials in adult fsgs: Lessons learned and the road forward. Nat. Rev. Nephrol. 17, 619\u2013630. https:\/\/doi.org\/10.1038\/s41581-021-00427-1 (2021).","journal-title":"Nat. Rev. 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Clinical Trial, Phase III Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov\u2019t Competing interests: BT has received consulting and speaking fees (Roche, LFB, Grifols, GSK). MH has received personal fees from Roche. AK has received personal fees and non-financial support from Roche. XP has received speaking fees and honoraria (Pfizer, LFB, Roche) and a research grant (Pfizer)., arXiv:2969.5500.","DOI":"10.1136\/annrheumdis-2017-212878"},{"key":"32576_CR20","doi-asserted-by":"publisher","unstructured":"Smith, R.\u00a0M. et\u00a0al. Rituximab for remission maintenance in relapsing antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheumatism64, 3760\u20133769, https:\/\/doi.org\/10.1002\/art.34583 (2012). 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