Comparison of Obinutuzumab and Rituximab for Treating Primary Membranous Nephropathy
In a propensity-matched retrospective study of primary membranous nephropathy, obinutuzumab achieved higher remission rates than rituximab at 12 months (95% vs 67%) with a similar safety profile.
Background
Anti-CD20 monoclonal antibody therapy is established for primary membranous nephropathy (MN), but rituximab response is variable, with a substantial proportion of patients failing to respond. Obinutuzumab is a humanized type II anti-CD20 antibody with greater B-cell depletion capacity, prompting a direct comparison of effectiveness and safety against rituximab.
Study design
This was a retrospective study of 63 patients with primary MN (urine protein at least 3.5 g/24 h and eGFR at least 30 ml/min per 1.73 m2 despite 6 months of ACE inhibitor/ARB) treated with obinutuzumab (21 patients) or rituximab (42 patients), matched 1:2 by propensity score on age, sex, urine protein, eGFR, and anti-PLA2R antibody titers. The primary outcome was combined partial or complete remission at 12 months.
Key findings
At 12 months, the primary outcome was achieved in 20 of 21 obinutuzumab patients versus 28 of 42 rituximab patients (95% vs 67%; odds ratio 10.00; 95% CI 1.21-82.35; P=0.03), and complete remission was more frequent with obinutuzumab (38% vs 14%; OR 3.69; 95% CI 1.08-12.68; P=0.04). In the PLA2R-associated subgroup, obinutuzumab produced lower CD19 B-cell counts and a trend toward higher immunological remission at 6 months. Both regimens were well tolerated.
Clinical implications
Obinutuzumab was associated with higher odds of clinical remission than rituximab at 12 months in primary MN, possibly driven by greater immunological remission at 6 months, with a comparable safety profile. The retrospective, propensity-matched design and small sample size warrant confirmation in prospective head-to-head trials.
Category
Research
Source
Clinical Journal of the American Society of Nephrology
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