ArticleClinical kidney journal2026
Subcutaneous ofatumumab for remission maintenance in pediatric idiopathic nephrotic syndrome: a case series.
Article in Clinical kidney journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Background: Rituximab (RTX) is effective for pediatric frequently-relapsing or steroid-dependent nephrotic syndrome (FR/SDNS); however, some patients develop RTX resistance or severe hypersensitivity. Ofatumumab (OFA), a fully humanized anti-CD20 monoclonal antibody, represents a potential alternative, yet its use in children remains poorly documented. This study evaluates the feasibility and safety of low-dose subcutaneous (SC) OFA in children with complicated FR/SDNS who are RTX resistant or intolerant. Methods: We retrospectively analyzed five pediatric patients (median age 14.8 years) with FR/SDNS and a history of RTX resistance or hypersensitivity. Each patient received a standardized SC OFA dose of 20 mg. B-cell depletion (CD19⁺ <1%), serum IgG levels, and adverse events-graded according to the Common Terminology Criteria for Adverse Events (CTCAE)-were monitored throughout follow-up. The primary endpoint was relapse-free remission within 12 months of the last OFA dose. Results: SC OFA achieved peripheral B-cell depletion in all patients, with a median duration of 5 months. Within 12 months, 80% (4/5) of patients maintained remission. One patient with previous severe anti-CD20 hypersensitivity tolerated SC OFA with mild (Grade 2) symptoms after ibuprofen premedication. No severe infections or exacerbations of hypogammaglobulinemia were documented. Conclusions: Low-dose SC OFA is a feasible preemptive therapy for remission maintenance in pediatric FR/SDNS, particularly for those with RTX resistance or intolerance. This outpatient-compatible route may reduce hypersensitivity risks and healthcare costs. Larger prospective trials are warranted to confirm long-term efficacy.
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