Prospective Cohort Study of Obinutuzumab in Rituximab-Resistant Primary Membranous Nephropathy
In 20 patients whose membranous nephropathy had failed rituximab, the next-generation anti-CD20 antibody obinutuzumab induced remission in 16 with no relapses over follow-up, offering a rescue option for refractory disease.
Background
About 30% of patients with primary membranous nephropathy and persistent nephrotic syndrome fail rituximab through mechanisms that a more potent glycoengineered anti-CD20 antibody could overcome. This prospective single-center trial gave three 1000 mg obinutuzumab infusions to 20 adults with rituximab-resistant disease.
Key findings
At 12 months, 16 patients met the composite endpoint of normo-albuminemia plus complete or partial remission (4 complete), and no patient who remitted relapsed. Median 24-hour proteinuria fell from 5.7 to 1.3 g/day, serum albumin rose from 2.9 to 3.9 g/dl, GFR stabilized, and both B cells and anti-PLA2R antibodies were depleted.
Safety
Treatment was described as safe and well-tolerated; when total B cells re-emerged by 24 months, this occurred without a rise in anti-PLA2R antibodies, proteinuria, or clinical relapse.
Category
Research
Source
Kidney International Reports
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