Japanese clinical practice patterns of rituximab treatment for minimal change disease in adults 2021: A web-based questionnaire survey of certified nephrologists

TL;DR

This study surveyed Japanese nephrologists about their use of rituximab for adult minimal change disease, finding that lack of insurance coverage and hospital type influence treatment practices.

Contribution

The study provides insights into clinical practice patterns and barriers to rituximab use for adult MCD in Japan, where treatment is not officially reimbursed.

Findings

Nephrologists at university hospitals and high biopsy-volume facilities are more likely to use rituximab for MCD.

Lack of insurance coverage is the main reason for withholding rituximab treatment.

Common regimens include a single 375 mg/m2 dose for induction and maintenance every 6 months.

Abstract

In Japan, rituximab (RTX) for adult-onset frequently relapsing (FR)/steroid-dependent (SD) minimal change disease (MCD) is not explicitly reimbursed by insurance, and its standard regimen has not been established.

We conducted a cross-sectional web-based survey between November and December 2021. The participants were nephrologists certified by the Japanese Society of Nephrology and answered 7 items about RTX for adult MCD. Factors related to the experience of RTX administration at their facilities were estimated by generalized estimating equations.

Of 380 respondents, 181 (47.6%) reported the experience of RTX use for adult MCD at their current facilities. Those who worked at university hospitals (vs. non-university hospitals, proportion difference 13.7%) and at facilities with frequent kidney biopsies (vs. 0 cases/year, 19.2% for 1–40 cases/year; 37.9% for 41–80 cases/year; 51.9% for ≥ 81 cases/year) used RTX more frequently. Of 181 respondents, 28 (15.5%) answered that there was no insurance coverage for RTX treatment. Of 327 respondents who had the opportunity to treat MCD, which was a possible indication for RTX, 178 (54.4%) indicated withholding of RTX administration. The most common reason was the cost due to lack of insurance coverage (141, 79.2%). Regarding RTX regimens for FR/SD MCD, introduction treatment with a single body surface area-based dose of 375 mg/m2 and maintenance treatment with a 6-month interval were the most common.

This survey revealed the nephrologists’ characteristics associated with RTX use, the barriers to RTX use, and the variation in the regimens for adult MCD in Japan.

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