Kidney Week

Abstract: TH-OR91

B Cell Depleting Agents and Outcomes in Membranous Nephropathy

Session Information

• Podocytopathies and Membranous Nephropathy: Clinical Advances
  October 24, 2024 | Location: Room 1, Convention Center
  Abstract Time: 04:30 PM - 04:40 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Almaani, Salem, The Ohio State University, Columbus, Ohio, United States

Salem Almaani, MBBS, MS, FASN

• Chen, Dhruti P., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Dhruti P. Chen, MD

• Helmuth, Margaret, University of Michigan, Ann Arbor, Michigan, United States

Margaret Helmuth, MA

• Smith, Abigail R., Northwestern University, Evanston, Illinois, United States

Abigail R. Smith, PhD

• Derebail, Vimal K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Vimal K. Derebail, MD, MPH, FASN

Group or Team Name

• CureGN Membranous Nephropathy Writing Group.

Background

B cell depleting therapy (BCDT) is increasingly used in membranous nephropathy (MN). We hypothesized that BCDT improves outcomes in MN and leads to faster remission in those with anti-PLA2R antibodies.

Methods

Use of BCDT among MN patients in Cure Glomerulonephropathy (CureGN) was reviewed. Interrupted time series analysis (IST) was done for eGFR slope prior and post treatment, including only participants with ≥2 eGFR values before and within 2 years post-therapy initiation. Time to remission was compared in those with negative vs. positive anti-PLA2R antibodies (any time), excluding those without definitive testing.

Results

In the MN cohort (n = 623), 456 (72%) patients were treated with non-B cell directed therapy and 215 (47%) of those had no BCDT use throughout their disease follow-up. 277 (44%) of MN patients had BCDT during their disease follow up, a majority (93%) were treated with rituximab. We compared eGFR trajectory pre and post therapy (n= 183 for those who received BCDT and n=88 who received other immunosuppressives but no BCDT). Among those receiving BCDT, eGFR slope (standard deviation) after treatment was -0.86 (0.93) mL/min/1.73m² compared to -3.04 (1.45) mL/min/1.73m² in patients receiving other immunosuppression (who never received BCDT), Figure 1A. Among those without anti-PLA2R antibodies (n=71) or with anti-PLA2R antibodies (n=113) treated with BCDT at time of active disease, there was no statistically significant difference in time to remission (median time to remission 2.4 vs. 3.8 years, respectively, logrank p = 0.097, Figure 1B).

Conclusion

BCDT is associated with decreased rate of eGFR decline in MN patients when compared to other therapies. Time to remission after BCDT is not influenced by anti-PLA2R status though there is a trend to faster remission among PLA2R negative patients.

Funding

• NIDDK Support