PARTIAL REMISSION, COMPLETE REMISSION, AND RELAPSE IN PATIENTS WITH PRIMARY MEMBRANOUS GLOMERULOPATHY AT 24 MONTHS OF TREATMENT WITH TWO RITUXIMAB REGIMENS.

 

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PARTIAL REMISSION, COMPLETE REMISSION, AND RELAPSE IN PATIENTS WITH PRIMARY MEMBRANOUS GLOMERULOPATHY AT 24 MONTHS OF TREATMENT WITH TWO RITUXIMAB REGIMENS.

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Ariana María
Martinez Sánchez
Ariana María Martinez Sánchez dra.ariana.martinez.nefro@gmail.com Mexican Social Security Institute Nephrology Mexico city Mexico *
Ricardo Ibarra Valenzuela ritch_93_6@hotmail.com Mexican Social Security Institute Nephrology Hermosillo Mexico -
David García Ramírez dr.garcia.nefro@gmail.com Mexican Social Security Institute Nephrology Mexico City Mexico -
José Fernando Real García fernando.real@uabc.edu.mx Mexican Social Security Institute Nephrology Mexicali Mexico -
Julio David Rios Ramírez Julio.rios93@outlook.com Mexican Social Security Institute Nephrology Mexicali Mexico -
Abraham Edgar Garcia Ramos dr.gracia.dmm@gmail.com Mexican Social Security Institute Internal Medicine Mexico City Mexico -
Luis Enrique Alvarez Rangel luis.enrique.alvarez.rangel@gmail.com Mexican Social Security Institute Nephrology Mexico City Mexico -
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Primary membranous glomerulopathy (MN) is the leading cause of nephrotic syndrome (SN) in adults worldwide. As part of the treatment for MN, immunosuppression is indicated in patients with persistent NS, with rituximab emerging as a first-line therapy; however, different dosing regimens exist, and there is no consensus on which is most effective. The study aimed to compare the frequency of partial remission (PR), complete remission (CR), and relapses in patients with primary MN treated with two different rituximab regimens.

 It was a retrospective study in adults with biopsy-proven MN and NS attended at National Medical Center “La Raza” in Mexico City. All patients received Rituximab as first-line therapy. Patients were divided into two groups according to rituximab regimen received: 1) patients who received a regimen of 375 mg/m² of body surface area intravenously once a week for four consecutive weeks, 2) patients who received a regimen of 1 g intravenously on days 1 and 15. In patients who did not achieve complete remission at 6 months, this regimen was repeated once. In both groups, the frequency of partial remission, complete remission, partial + complete remission, and relapse was compared at 6, 12, 18, and 24 months of treatment.

For comparisons between the groups with both rituximab regimens, Student's t-test and chi-square test were used, with a p-value <0.05 considered significant.

A review of medical records, between January 2016 and December 2024 identified 51 patients with biopsy- proven membranous nephropathy and nephrotic syndrome, aged de 49.25 ± 12.62 years, with a predominance of the male gender (37 cases, 72.5%). The clinical presentation at the time of the biopsy was with proteinuria of 7.34 ± 3.82 g/24 hours, serum creatinine of 1.09 ± 0.54 mg/dl, serum albumin of 2.64 ± 0.86 mg/dl. 26 patients who received the two-dose rituximab regimen (1 gram on days 1 and 15) and 25 patients who received the four-dose rituximab regimen (375 mg/m² of body surface area weekly for four weeks). During 24 months of follow-up, complete remission (CR) was identified in 12 patients (23.5%), partial remission (PR) in 16 patients (31.4%), and partial plus complete remission in 28 patients (54.9%). At the end of the 24-month follow-up, partial remission was achieved in 30.8% (8 cases) of patients who received two doses of rituximab, compared to 32.0% (8 cases) of patients who received four doses of rituximab, p = 0.925. Although the two-dose rituximab treatment group achieved a higher proportion of complete remissions at 6 and 12 months, at the end of the 24-month follow-up, no significant difference was observed compared to the group treated with four doses of rituximab (7 cases [26.9%] vs. 5 cases [20%], respectively, p=0.560).




In patients with primary membranous glomerulopathy treated with rituximab, both therapeutic regimens demonstrated similar efficacy when comparing the frequency of partial remission, complete remission, and relapses.

Kewords