Introduction:
According to the KDIGO guidelines, rituximab is recommended as the first-line therapy for primary membranous nephropathy (PMN). Most clinical trials and observational studies report remission in approximately 60% of cases. However, a pilot study by XXX et al. demonstrated improved remission rates with an additional dose administered at 3 months. In this abstract, we present the clinical remission rates in patients with PMN treated with a three-dose rituximab regimen.
Methods:
This single-centre, retrospective study was conducted in the Department of Nephrology at PGIMER, Chandigarh, India. Adult patients with biopsy-proven PMN who received rituximab as initial therapy or for relapsing disease were included. Patients with resistant disease, active viral replication, uncontrolled diabetes mellitus, or systemic lupus erythematosus (SLE) were excluded. All patients received rituximab at a dose of 1 g on days 0 and 15 (±10 days), with an additional dose administered between months 3 and 5. Clinical remission was defined according to KDIGO guidelines.
Results:
A total of 61 patients were included in the study. The mean age of the patients was 41.52 ± 15.97 years. Baseline proteinuria, serum creatinine, and serum albumin levels were 7.23 g/day (IQR 5.60–10.33), 0.85 mg/dL (IQR 0.69–1.29), and 2.55 ± 0.62 g/dL, respectively. Forty-two patients tested positive for anti-PLA2R antibodies, with a median level of 233.50 RU/mL (IQR 84.73–540.34); 23 (53.48%) patients had anti-PLA2R levels exceeding 150 RU/mL. At 12 months, proteinuria, serum creatinine, and serum albumin were 1.54 g/day (IQR 0.41–4.07), 0.89 mg/dL (IQR 0.72–1.09), and 3.83 ± 0.66 g/dL, respectively. At the last follow-up, these values were 1.44 g/day (IQR 0.59–3.28), 0.98 mg/dL (IQR 0.79–1.28), and 4.01 ± 0.51 g/dL, respectively. By 12 months, 41 patients (67.21%) achieved clinical remission (12 complete remission [CR] and 29 partial remission [PR]), and at the last follow-up, 47 patients (77.04%) were in clinical remission. Rituximab administration was well tolerated, with an acceptable safety profile.
Conclusions:
The administration of an additional dose of rituximab between months 3 and 5 induces remission in approximately three-fourths of patients with primary membranous nephropathy, including those with anti-PLA2R levels greater than 150 RU/mL.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.