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Responders will be randomized to either receive re-treatment with further courses of rituximab (four doses given at weekly intervals) provided the time to progression is more than 6 months, or maintenance rituximab given as one infusion every 12 weeks until progression or unacceptable toxicity.
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Relapse was treated with repeat further courses of steroid therapy, and/or additional second-line immunosuppressive therapy, at the discretion of the investigators.
No cases of reduction of more than 25% of the MTX dose in further courses with respect to the planned dose were observed.
Likewise, the initial height of the PCT concentrations did not correlate with the further course of the disease.
The usual approach from both centers was to treat with a further course of steroids and add in azathioprine (to a dose of 2 mg/kg/day), which was started in 41 patients (36% of the cohort and 71% of those who relapsed; Table 1).
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Typically a large number of children with NS develop clinical relapse following initial response to steroids, and are treated with further steroid courses.
Thereafter, he received further courses of steroids, vincristine, and cyclophosphamide, with any improvements, until the age of 21 when he refused any further treatments.
The MTX dose of the further courses was increased by more than 25% with respect to the MTX dose of the first course in three (7%) cases.
SPECT investigation performed at the 2 time points after reconstruction showed a significantly higher tracer uptake in grafts with an uncomplicated further course than in those that developed complications.
The staff had access to anthropometric measures and blood samples collected at baseline and used these in their first consultation with patients to plan the further course.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com