Efficacy of rituximab (RTX) versus cyclophosphamide (CTX) in the treatment of steroid dependent minimal change disease (MCD) in adult population of Islamabad, Pakistan.

Abstract

Objective: To determine the efficacy of rituximab (RTX) versus cyclophosphamide (CTX) in the treatment of steroid dependent MCD in adult population of Islamabad, Pakistan. Study Design: Randomized Controlled Trial. Setting: Department of General Medicine, PAF Hospital, Islamabad. Period: One and Half Year November 2022 to April 2024. Methods: A total number of 60 patients’ ≥ 18 years of age with steroid dependent MCD were selected for the study and divided in 2 groups of 30 patients each using block randomization. In RTX group, patients were given two doses of injectable RTX in a dose of 1000 mg two weeks apart. While in CTX group, oral CTX was given in a dose of 2–2.5mg/kg/d for 8 weeks. Efficacy was determined in terms of incidence of relapse, steroid withdrawal and making patient drug-free. Results: The mean age of patients in this study was 41.11±13.5 years. The results showed that RTX was significantly more effective than CTX in reducing the incidence of relapse (12 Vs 21 patients, p-value=0.02), in steroid withdrawal (27 Vs 16 patients, p-value=0.002) and in making patients drug free compared to CTX (27 Vs 12 patients, p ˂0.0001). Conclusion: RTX is more effective in reducing the relapse of nephrotic syndrome in adults with steroid dependent MCD compared to CTX and helps in making the patient drug free.