Ofatumumab for the treatment of childhood nephrotic syndrome

• Type of Material: Article
• Authors: Chia-shi Wang, Emory University; Rochelle Schmidt Liverman, Children's Healthcare Atlanta; Rouba Garro, Emory University; Roshan P George, Emory University; Anastacia Glumova, Children's Healthcare Atlanta; Alana Karp, Emory University; Stephanie Jernigan, Emory University; Barry L Warshaw, Emory University
• Language: English
• Date: 2017-05-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, IPNA.
• Final Published Version (URL): http://dx.doi.org/10.1007/s00467-017-3621-8
• Title of Journal or Parent Work: Pediatric Nephrology
• ISSN: 0931-041X
• Volume: 32
• Issue: 5
• Start Page: 835
• End Page: 841
• Grant/Funding Information: Chia-shi Wang is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454.
• Keywords: Urology & Nephrology; CONTROLLED-TRIAL; CHILDREN; Pediatrics; KDIGO; Focal segmental; CLINICAL-FEATURES; Nephrotic syndrome; Life Sciences & Biomedicine; Children; Glomerulosclerosis; MANAGEMENT; MULTICENTER; RITUXIMAB; Science & Technology; Ofatumumab; GUIDELINES
• Research Categories: Health Sciences, General; Health Sciences, Immunology

Abstract

Background: Ofatumumab is a humanized anti-CD20 monoclonal antibody that has recently garnered interest as a potential therapeutic agent for nephrotic syndrome. We report our center’s experience in administering ofatumumab to five pediatric patients with idiopathic nephrotic syndrome. Methods: Between March 2015 and November 2016, five patients were treated with ofatu mumab. One patient had post-transplant recurrent focal segmental glomerulosclerosis (FSGS) which had been resistant to plasmapheresis and numerous immunosuppressive agents. Four patients had nephrotic syndrome in their native kidneys, one with initial steroid-resistant disease and the others with subsequent development of steroid resistance. Two of the patients were treated with a desensitization protocol after experiencing hypersensitivity reactions to ofatumumab. Results: One patient did not complete ofatumumab treatment due to infusion reactions. Of the four remaining patients, three achieved complete remission after treatment, and one achieved partial remission. One of the patients achieving complete remission represents the first reported case of successful treatment of post-transplant recurrent FSGS using ofatumumab. Two patients who received ofatumumab with our desensitization protocol were able to complete their treatments after initially experiencing hypersensitivity reactions. Conclusions: Ofatumumab may be an effective treatment for refractory childhood nephrotic syndrome and post-transplant recurrent FSGS. A desensitization protocol may be helpful to address hypersensitivity reactions.