ESPN 50th Annual Meeting

ESPN 2017


 
Quality of life in idiopathic nephrotic syndrome: comparison between oral immunosuppression and rituximab
APHAIA ROUSSEL 1 IULIA STOICA 1 JEAN DANIEL DELBET 1 TIM ULINSKI 1

1- ARMAND-TROUSSEAU HOSPITAL, PARIS AND UNIVERSITY UPMC, PARIS 6
 
Introduction:

Severe forms of idiopathic nephrotic syndrome (INS) require immunosuppressive therapy, such as oral treatment (calcineurine inhibitors or mycophenolate mofetil) or rituximab (RTX). Our objective was to compare the quality of life (QOL) between patients treated with oral drugs or RTX.

Material and methods:

This prospective multicentric, observational study compared the QOL with a standardized questionnaire (Kindl®) given to children aged from 7 to 17 years old, with a steroid dependent or steroid resistant INS separated in three treatment groups (oral drugs or rituximab or both) in stable remission. The questionnaire was completed during an outpatient consultation and consisted of 30 questions concerning physical and emotional well-being, self-esteem, family, friends, school, and disease resulting in a global score of 0 to 100. A propensity score was used to compensate the absence of randomisation.

Results:

110 patients (72 boys, 38 girls) with a mean age of 11.6 ± 3.1 years were included in three French pediatric nephrology centres. There were 71 patients in the oral drugs group, 27 in the RTX group and 12 in the oral drugs and RTX group. 13.6% of patients had a steroid resistant form of INS (9.9% in the oral drugs group and 18.5% in the RTX group). The number of relapses was 5.8±3.7 (4.7±2.9 in oral drugs group and 8.2±4.1 in RTX group). The score in the whole study population was 74.5±11.03 (74.1±15.6 in the RTX group, 74.9±10.5 in the oral drugs group (p=0.73). Even after an adjustement using a propensity score there was no statistical difference (p=0.6).

Conclusions:

Quality of life in patients with oral and IV treatment in patients with severe forms of INS is not different. The treatment choice should include the opinion of the patient and his/her family. Neither clinical nor QOL parameters are sufficient to decide for or against RTX treatment.