Kidney Week

Abstract: TH-PO593

Obinutuzumab Is Effective and Safe for Membranous Nephropathy with Very High Risk: A Retrospective Study from China

Session Information

• Membranous Nephropathy, FSGS, and Minimal Change Disease
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Chen, Duqun, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

Duqun Chen, MD

• Li, Hui, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Nanjing medical University, Nanjing, China

Hui Li, MD, APN

• Tu, Yuanmao, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

Yuanmao Tu, DrMed, MA, DrPH

• Wang, Youliang, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

Youliang Wang, DrMed

• Qiu, Dandan, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

Dandan Qiu

• Zuo, Ke, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

Ke Zuo, MD

• Cheng, Zhen, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

Zhen Cheng, MD

Background

Membranous nephropathy (MN) is a common cause of nephrotic syndrome (NS) in adults. Factors considered to place a patient at very high risk for progression include life-threatening complications related to NS and severe renal dysfunction. The present study aimed to explore the efficiency and safety of Obinutuzumab for MN with very high risk in a retrospectively cohort.

Methods

MN patients with serum anti-phospholipase A2 receptor antibody (aPLA2Rab) ≥14RU/ml with very high risk (venous thromboembolic events, n=10, serum creatinine≥1.5mg/dl, n=16) received Obinutuzumab treatment (1g×2) in the National Clinical Medical Research Center for Renal Diseases at Jinling Hospital from October 2022 to November 2023 were retrospectively analyzed. Immunological complete remission is defined as aPLA2Rab<2RU/ml. B cell depletion is defined as CD20+cells<5/ul. All patients were followed more than 6 months.

Results

26 MN patients including 23 males and 3 females was enrolled in the present study, with a mean proteinuria of 11g/24h at baseline. Complete (proteinuria <0.5g/24h) or partial (proteinuria <3.5g/24h with ≥50% reduction vs baseline) remission was achieved in 35% and 61.5% patients at month 3 and 6 respectively. B cell depletion rate was 100% and 88%, and immunological complete remission was 77% and 85% at month 3 and 6 respectively. aPLA2Rab titers progressively decreased by medians of 99% at month 6 compared to baseline. Obinutuzumab significantly reduced 24-hour proteinuria and increased serum albumin, and immunoglobulin G levels. Estimated glomerular filtration rate was significantly increased by an average of 32% in patients with serum creatinine ≥1.5mg/dl. Venous thrombosis was disappeared in 9 (90%) patients. 16 patients were followed more than 9 months and only one patient failed to response, a remission rate of 94% was achieved at month 9. Infusion-related adverse event was mostly mild. No patients died or progression into end stage kidney disease.

Conclusion

Obinutuzumab is safe and effective in the treatment of membranous nephropathy with very high risk. Large prospective studies are needed to validate these preliminary findings.

Funding

• Clinical Revenue Support