Long-term outcomes of rituximab treatment for primary membranous nephropathy
Long-term real-world cohorts confirm rituximab as an effective first-line therapy for primary membranous nephropathy, inducing complete or partial remission in roughly two-thirds to over 80% of patients with excellent multi-year renal survival and a favorable safety profile.
Background
Membranous nephropathy is a leading cause of nephrotic syndrome in adults. Identification of the phospholipase A2 receptor (PLA2R) as the target antigen in most patients provided the rationale for B-cell–depleting therapy, and rituximab has become a first-line option, especially for patients at moderate-to-high risk of kidney-function decline.
Study design
Evidence comes from randomized trials and large retrospective cohorts. In a 159-patient cohort with a median follow-up of about 62 months, patients were assessed for complete/partial remission, immunological (anti-PLA2R antibody) remission, and hard outcomes including end-stage kidney disease and eGFR loss greater than 50%. Additional cohorts (for example, 154 patients from China) and randomized trials such as RI-CYCLO evaluated rituximab against cyclic corticosteroid-cyclophosphamide regimens.
Key findings
In the long-term cohort, 88% of patients attained complete or partial remission, with failure to respond in about 12%; estimated renal survival was 97% at 5 years and around 95% at 10 years, comparing favorably with historical cyclophosphamide-based regimens. Prior immunosuppression and significant interstitial fibrosis/tubular atrophy predicted non-response. Anti-PLA2R antibody depletion tracked with—and often preceded—clinical remission.
Clinical implications
These data support rituximab as a durable, well-tolerated treatment that stabilizes or improves kidney function in primary membranous nephropathy, including some patients with reduced baseline eGFR. Anti-PLA2R antibody monitoring is useful for tracking disease activity and guiding therapy, and emerging agents such as obinutuzumab may benefit rituximab-resistant patients.
Category
Research
Source
Kidney International
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.