{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:15:38Z","timestamp":1789690538527,"version":"4.0.1"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,7,1]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Rituximab is being increasingly used in children with idiopathic nephrotic syndrome resistant to standard treatments. In spite of good initial response, rituximab responders always remain prone to further relapse, necessitating either repeat course of rituximab or addition of another steroid-sparing immunosuppressant.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n A retrospective analysis of baseline clinico-pathologic presentation and treatment outcome (complete remission, partial remission, or no response) was performed among 24 children with refractory-idiopathic SRNS over a follow-up period of 24 months. Children received 2 to 4 rituximab infusions (375 mg\/m2 weekly) depending on circulating B-cell level. At 3-month follow-up, a second course of rituximab was administered (if &gt;5 B cells\/mm3) along with MMF (1200 mg\/m2 per day) maintenance therapy.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Of 24 patients, 54% (13\/24) and 46% (11\/24) had minimal change disease and focal segmental glomerulosclerosis, respectively, on renal histopathology. After the first course of rituximab, 21% (5\/24) of children achieved complete remission; however, most (4\/5) of them relapsed again at a median interval of 53 (interquartile range 46\u201372) days. Depending on response to the first course of rituximab, MMF was started on 15 children at 3 months. After 6 months, 67% (10\/15) of children on MMF achieved complete remission and 33% (5\/15) remained at partial remission. At 24 months overall, 25% (6\/24) and 42% (10\/24) of children were in complete remission and partial remission, respectively; 33% (5\/15) of children continued sustained complete remission after postrituximab-MMF maintenance therapy in comparison with no sustained complete remission with rituximab alone at 24 months (P &lt; .001).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n MMF may be an effective and safe maintenance therapy to consider as an additive immunosuppressant after induction with rituximab in maintaining remission among children with refractory SRNS.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2015-0486","type":"journal-article","created":{"date-parts":[[2015,6,23]],"date-time":"2015-06-23T00:20:39Z","timestamp":1435018839000},"page":"e132-e139","source":"Crossref","is-referenced-by-count":48,"title":["Mycophenolate Mofetil Following Rituximab in Children With Steroid-Resistant Nephrotic Syndrome"],"prefix":"10.1542","volume":"136","author":[{"given":"Biswanath","family":"Basu","sequence":"first","affiliation":[{"name":"Division of Pediatric Nephrology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.K.S.","family":"Mahapatra","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirmal","family":"Mondal","sequence":"additional","affiliation":[{"name":"Community Medicine and Statistics, NRS Medical College and Hospital, Kolkata, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2015,7,1]]},"reference":[{"issue":"3","key":"2021120821013315100_B1","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s00467-012-2304-8","article-title":"Treatment of steroid-resistant nephrotic syndrome in children: new guidelines from KDIGO.","volume":"28","author":"Lombel","year":"2013","journal-title":"Pediatr Nephrol"},{"issue":"9","key":"2021120821013315100_B2","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1001\/archpedi.1988.02150090083029","article-title":"Cyclosporine therapy for steroid-resistant nephrotic syndrome. A controlled study.","volume":"142","author":"Garin","year":"1988","journal-title":"Am J Dis Child"},{"issue":"1","key":"2021120821013315100_B3","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1681\/ASN.V7156","article-title":"A randomized double-blind placebo-controlled trial of cyclosporine in steroid-resistant idiopathic focal segmental glomerulosclerosis in children.","volume":"7","author":"Lieberman","year":"1996","journal-title":"J Am Soc Nephrol"},{"issue":"6","key":"2021120821013315100_B4","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1038\/ki.1993.194","article-title":"A randomized trial of cyclosporine in steroid-resistant idiopathic nephrotic syndrome.","volume":"43","author":"Ponticelli","year":"1993","journal-title":"Kidney Int"},{"issue":"8","key":"2021120821013315100_B5","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1038\/ki.2011.195","article-title":"Clinical trial of focal segmental glomerulosclerosis in children and young adults.","volume":"80","author":"Gipson","year":"2011","journal-title":"Kidney Int"},{"issue":"7878","key":"2021120821013315100_B6","first-page":"423","article-title":"Prospective, controlled trial of cyclophosphamide therapy in children with nephrotic syndrome. Report of the International Study of Kidney Disease in Children.","volume":"2","author":"International Study of Kidney Disease in Children","year":"1974","journal-title":"Lancet"},{"issue":"5","key":"2021120821013315100_B7","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1007\/s004670050167","article-title":"Cyclophosphamide does not benefit patients with focal segmental glomerulosclerosis. A report of the International Study of Kidney Disease in Children.","volume":"10","author":"Tarshish","year":"1996","journal-title":"Pediatr Nephrol"},{"issue":"10","key":"2021120821013315100_B8","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1038\/ki.2012.238","article-title":"Treatment with tacrolimus and prednisolone is preferable to intravenous cyclophosphamide as the initial therapy for children with steroid-resistant nephrotic syndrome.","volume":"82","author":"Gulati","year":"2012","journal-title":"Kidney Int"},{"issue":"12","key":"2021120821013315100_B9","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.2215\/CJN.03470410","article-title":"Efficacy and safety of treatment with rituximab for difficult steroid-resistant and -dependent nephrotic syndrome: multicentric report.","volume":"5","author":"Gulati","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"issue":"3","key":"2021120821013315100_B10","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s00467-009-1376-6","article-title":"Rituximab in refractory nephrotic syndrome.","volume":"25","author":"Prytu\u0142a","year":"2010","journal-title":"Pediatr Nephrol"},{"issue":"4","key":"2021120821013315100_B11","first-page":"249","article-title":"Rituximab in the treatment of nephrotic syndrome: a systematic review.","volume":"7","author":"Otukesh","year":"2013","journal-title":"Iran J Kidney Dis"},{"issue":"13","key":"2021120821013315100_B12","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1056\/NEJMc1308488","article-title":"Ofatumumab for rituximab-resistant nephrotic syndrome.","volume":"370","author":"Basu","year":"2014","journal-title":"N Engl J Med"},{"issue":"3","key":"2021120821013315100_B13","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1681\/ASN.2008030287","article-title":"New equations to estimate GFR in children with CKD.","volume":"20","author":"Schwartz","year":"2009","journal-title":"J Am Soc Nephrol"},{"issue":"7","key":"2021120821013315100_B14","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1007\/s00467-009-1191-0","article-title":"Single dose of rituximab for refractory steroid-dependent nephrotic syndrome in children.","volume":"24","author":"Kamei","year":"2009","journal-title":"Pediatr Nephrol"},{"issue":"3","key":"2021120821013315100_B15","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s00467-009-1377-5","article-title":"Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine.","volume":"25","author":"Fujinaga","year":"2010","journal-title":"Pediatr Nephrol"},{"issue":"8","key":"2021120821013315100_B16","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1007\/s00467-008-0814-1","article-title":"Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases.","volume":"23","author":"Guigonis","year":"2008","journal-title":"Pediatr Nephrol"},{"issue":"6","key":"2021120821013315100_B17","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1007\/s00467-010-1465-6","article-title":"Rituximab efficiency in children with steroid-dependent nephrotic syndrome.","volume":"25","author":"Sellier-Leclerc","year":"2010","journal-title":"Pediatr Nephrol"},{"issue":"11","key":"2021120821013315100_B18","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1097\/TP.0b013e3181735723","article-title":"B cell survival in intragraft tertiary lymphoid organs after rituximab therapy.","volume":"85","author":"Thaunat","year":"2008","journal-title":"Transplantation"},{"issue":"6","key":"2021120821013315100_B19","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1007\/s10157-011-0510-5","article-title":"Induction of remission following a single dose of rituximab alone in a patient with minimal change nephrotic syndrome.","volume":"15","author":"Amemiya","year":"2011","journal-title":"Clin Exp Nephrol"},{"issue":"10","key":"2021120821013315100_B20","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s00467-011-1894-x","article-title":"Should we consider MMF therapy after rituximab for nephrotic syndrome?","volume":"26","author":"Filler","year":"2011","journal-title":"Pediatr Nephrol"},{"issue":"10","key":"2021120821013315100_B21","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1007\/s00467-011-1886-x","article-title":"Maintenance therapy with mycophenolate mofetil after rituximab in pediatric patients with steroid-dependent nephrotic syndrome.","volume":"26","author":"Ito","year":"2011","journal-title":"Pediatr Nephrol"},{"issue":"2","key":"2021120821013315100_B22","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s00467-008-1030-8","article-title":"Role of mycophenolate mofetil in remission maintenance after a successful response to rituximab.","volume":"24","author":"Sharma","year":"2009","journal-title":"Pediatr Nephrol"},{"issue":"10","key":"2021120821013315100_B23","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1681\/ASN.2012121200","article-title":"Mycophenolate mofetil versus cyclosporin A in children with frequently relapsing nephrotic syndrome.","volume":"24","author":"Gellermann","year":"2013","journal-title":"J Am Soc Nephrol"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/136\/1\/e132\/1093806\/peds_2015-0486.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/136\/1\/e132\/1093806\/peds_2015-0486.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T00:58:38Z","timestamp":1639011518000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/136\/1\/e132\/29189\/Mycophenolate-Mofetil-Following-Rituximab-in"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,7,1]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2015,7,1]]},"published-print":{"date-parts":[[2015,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2015-0486","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,7,1]]}}}