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Background <p>Rituximab is considered a therapeutic option in children with refractory nephrotic syndrome (RNS). However, the efficacy and safety of rituximab treatment remain unclear.</p> Objective <p>This study systematically evaluated the clinical effectiveness and related adverse event profiles of rituximab compared with other immunosuppressants in children with RNS.</p> Method <p>Two independent investigators conducted the methodological rigor evaluation in a double-blind manner. Statistical analyses were performed using RevMan 5.4.</p> Results <p>Relative to other&#xa0;conventional second-line agents, rituximab therapy presented a significantly increased relapse-free survival rate [vs. tacrolimus: OR = 3.42, 95% CI = 1.96–5.94, <i>P</i> &lt; 0.01]. Fewer adverse drug reactions occurred in patients with rituximab than with other immunosuppressants [vs. cyclophosphamide: OR = 0.18, 95% CI = 0.04–0.89, <i>P</i> = 0.03; vs. tacrolimus: OR = 0.26, 95% CI = 0.07–0.92, <i>P</i> = 0.04]. The application of rituximab increased the steroid-discontinued rate and decreased the corticosteroid dose in the treatment [vs. cyclophosphamide: OR = 5.46, 95% CI = 2.00–14.92, <i>P</i> = 0.0009; vs. tacrolimus: OR = 3.42, 95% CI = 1.67–7.01, <i>P</i> = 0.0008].</p> Conclusion <p>Our study demonstrates rituximab’s superior efficacy and safety profile compared to conventional second-line immunosuppressants in pediatric RNS, particularly regarding steroid minimization.&#xa0;Systematic review registration number: CRD420251082051.</p> Graphical Abstract <p></p>

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Rituximab in pediatric refractory nephrotic syndrome: a systematic review and meta-analysis evaluating therapeutic efficacy and adverse event profiles

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月8日

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  • Junchao Deng,
  • Lizhen Zhu,
  • Xiaoshi Zhu

摘要

Background

Rituximab is considered a therapeutic option in children with refractory nephrotic syndrome (RNS). However, the efficacy and safety of rituximab treatment remain unclear.

Objective

This study systematically evaluated the clinical effectiveness and related adverse event profiles of rituximab compared with other immunosuppressants in children with RNS.

Method

Two independent investigators conducted the methodological rigor evaluation in a double-blind manner. Statistical analyses were performed using RevMan 5.4.

Results

Relative to other conventional second-line agents, rituximab therapy presented a significantly increased relapse-free survival rate [vs. tacrolimus: OR = 3.42, 95% CI = 1.96–5.94, P < 0.01]. Fewer adverse drug reactions occurred in patients with rituximab than with other immunosuppressants [vs. cyclophosphamide: OR = 0.18, 95% CI = 0.04–0.89, P = 0.03; vs. tacrolimus: OR = 0.26, 95% CI = 0.07–0.92, P = 0.04]. The application of rituximab increased the steroid-discontinued rate and decreased the corticosteroid dose in the treatment [vs. cyclophosphamide: OR = 5.46, 95% CI = 2.00–14.92, P = 0.0009; vs. tacrolimus: OR = 3.42, 95% CI = 1.67–7.01, P = 0.0008].

Conclusion

Our study demonstrates rituximab’s superior efficacy and safety profile compared to conventional second-line immunosuppressants in pediatric RNS, particularly regarding steroid minimization. Systematic review registration number: CRD420251082051.

Graphical Abstract