Healthcost and Clinical Benefits of Rituximab in Steroid Sensitive Nephrotic Syndrome: Perspective from a Middle-Income Country (Myritux)

Background: The use of Rituximab for frequently relapsing (FRNS) and steroid-dependent nephrotic syndrome (SDNS) is increasingly established. However, the use of Rituximab in resource-limited settings is constrained by its prohibitive cost. Methods: This retrospective study included all children aged 1 to 18 years with FRNS and SDNS. The costs incurred when using either Rituximab or cyclosporine were calculated and compared. Clinical data were retrieved from medical records. Results: Twelve patients received rituximab while 11 patients were treated with cyclosporine. Annualised relapse rate reduced from 5.07 to 1.52 in the Rituximab group and 1.01 in the cyclosporine group. Total health cost was MYR 75,339.81 in the rituximab group and MYR83,098.25 in the cyclosporine group. Cost to reduce one relapse with Rituximab was MYR 1,104.95 /episode compared to Cyclosporine, MYR 1,500.42 /episode. We observed a greater reduction in the amount of prednisolone use in the rituximab group (114.33mg/kg versus 99.91mg/kg in the cyclosporine group). Both demonstrated a significant reduction in their body mass index z-score. There were no infusion-related Reactions in the rituximab group and cyclosporin group were also well tolerated. Conclusion: This is the first study to compare the healthcare costs of using rituximab to be carried out in a middle-income country. Findings suggest that in such a setting, a single infusion of Rituximab as a steroid-sparing agent among children with steroid-sensitive nephrotic syndrome remains efficacious and feasible.