{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:30:44Z","timestamp":1792794644140,"version":"4.5.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Cure Glomerulonephropathy"},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research Fellowship","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Kidney Foundation of Canada KRESCENT Program","id":[{"id":"https:\/\/ror.org\/019a0gk53","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Women\u2019s College Hospital Research Institute","award":["U24DK100845"],"award-info":[{"award-number":["U24DK100845"]}],"id":[{"id":"https:\/\/ror.org\/04wx8hm39","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Women\u2019s College Hospital Research Institute","award":["U01DK100846"],"award-info":[{"award-number":["U01DK100846"]}],"id":[{"id":"https:\/\/ror.org\/04wx8hm39","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Women\u2019s College Hospital Research Institute","award":["U01DK100876"],"award-info":[{"award-number":["U01DK100876"]}],"id":[{"id":"https:\/\/ror.org\/04wx8hm39","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Women\u2019s College Hospital Research Institute","award":["U01DK100866"],"award-info":[{"award-number":["U01DK100866"]}],"id":[{"id":"https:\/\/ror.org\/04wx8hm39","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Women\u2019s College Hospital Research Institute","award":["U01DK100867"],"award-info":[{"award-number":["U01DK100867"]}],"id":[{"id":"https:\/\/ror.org\/04wx8hm39","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,31]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Children and young adults with nephrotic syndrome are commonly treated with steroid-sparing immunosuppressive medications. Rituximab is increasingly used in frequently relapsing disease, but the real-world comparative effectiveness of rituximab and calcineurin inhibitors is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using target trial methods, we emulated a pragmatic randomized controlled trial using observational data from two prospective nephrotic syndrome cohorts. We included children and adults (aged 1\u201340 years) with steroid-sensitive nephrotic syndrome that first initiated rituximab or calcineurin inhibitor treatment during follow-up. Randomization was emulated using overlap weighting of propensity scores for treatment assignment. The primary outcome was time-to-relapse, analyzed by weighted Cox proportional hazards models. Secondary outcomes were relapse counts, subsequent immunosuppressive treatment, kidney function, hypertension and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 372 eligible participants, 104 initiated rituximab and 268 initiated calcineurin inhibitors. Baseline characteristics were balanced after propensity score weighting. Mean age at medication initiation was 13.2 years, 61% were male and 69% had received prior steroid-sparing medications. Throughout a median 4.9-year (quartile 1\u20133, 2.0\u20137.2) follow-up, relapses occurred in 58 participants (56%) treated with rituximab and 209 (78%) treated with calcineurin inhibitors. There was no significant difference in time-to-relapse after rituximab vs calcineurin inhibitor treatment [weighted hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.59\u20131.38]. There were also no significant differences in relapse rates or kidney function decline. Participants treated with rituximab were at lower risk of developing hypertension (weighted HR 0.24, 95% CI 0.08\u20130.79).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using real-world data, there was no difference in relapse rates after rituximab vs calcineurin inhibitors among children and young adults with steroid-sensitive nephrotic syndrome. Steroid-sparing immunosuppression selection should be a shared decision, considering medication-specific side effects, costs, access, duration and adherence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf207","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T11:57:24Z","timestamp":1759406244000},"page":"776-785","source":"Crossref","is-referenced-by-count":1,"title":["Steroid-sparing drugs in children and young adults with nephrotic syndrome: a target trial emulation"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2223-0646","authenticated-orcid":false,"given":"Cal H","family":"Robinson","sequence":"first","affiliation":[{"name":"The Hospital for Sick Children Division of Nephrology, Department of Paediatrics, , Toronto, Ontario ,","place":["Canada"]},{"name":"Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children , Toronto, Ontario 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