Rituximab effectively prolongs steroid-induced remission of nephrotic syndrome: TURING

Compared with placebo, rituximab prolonged remission by more than 2 years in patients with nephrotic syndrome due to minimal change disease or focal segmental glomerulosclerosis who responded to steroid treatment, according to clinical trial data reported by Dr Lisa Willcocks (Cambridge University Hospital, UK) and Prof. Megan Griffith (Imperial College London, UK) [1].

The TURING trial (EudraCT 2018-004611-50) was a phase 3, randomised, placebo-controlled trial evaluating rituximab in patients with nephrotic syndrome secondary to minimal change disease and focal segmental glomerulosclerosis. Patients were eligible if they had de novo or relapsing disease. At study entry, all patients received high-dose prednisolone until remission or for up to 16 weeks. Simultaneously, patients were randomised to receive either rituximab (1 g administered at weeks 0, 2, and 26) or matching placebo. Patients who did not achieve remission with prednisolone by week 16 were excluded from the primary analysis. The primary endpoint was the time from remission to relapse. Of the 149 patients enrolled, 122 achieved remission by week 16 and were included in the analysis.

Overall, 45 of 59 patients in the placebo group and 22 of 63 patients in the rituximab group relapsed. The median time to relapse was 22 weeks in the placebo group and was not reached in the rituximab group, corresponding to an HR of 0.22 in favour of rituximab (95% CI 0.13–0.37; P<0.0001). Subgroup analyses showed consistent results across groups defined by disease presentation (de novo vs relapsing disease), disease type (minimal change disease vs focal segmental glomerulosclerosis), prednisolone regimen, sex, ethnicity, and age at first presentation with nephrotic syndrome. Adverse events reported more frequently with rituximab included infusion-related reactions, infections, and hypogammaglobulinaemia.

“Three 1 g doses of rituximab can maintain remission for more than 2.8 years,” concluded Prof. Griffith. She added that “patients were exposed to high-doses of steroids during the trial, and we as a community need additional strategies to reduce glucocorticoid exposure in our patients.”

Willcocks L, et al. The Use of Rituximab In the treatment of Nephrotic Glomerulonephritis (TURING): a multicentre, double-blind, randomised, placebo-controlled trial. ERA 2026, 3–6 June. Glasgow, Scotland.