Kidney Week

Abstract: TH-PO591

A Comparative Analysis of Efficacy of Rituximab in Patients with Primary Membranous Nephropathy

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

• Zhang, Qianwei, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China

Qianwei Zhang, MS

• Xie, Liyi, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China

Liyi Xie, PhD

Background

The efficacy of rituximab in patients with primary membranous nephropathy(PMN) has been confirmed.The study was conducted to analyze the efficacy of rituximab in PMN patients by comparing with supportive and immunotherapy therapy.The optimal treatment strategies for membranous nephropathy were proposed.

Methods

Patients diagnosed with PMN by clinical manifestations of nephrotic syndrome and began initial treatment were divided into four treatment groups:rituximab(RTX);low-dose glucocorticoid with tacrolimus or cyclophosphamide(CTX);supportive treatment.Collecte the data consecutively for 30 months to conduct a single-center retrospective study.

Results

161 patients underwent the study totally,93 were male(57.76%) and 68 were female(42.24%).The mean age was 50.50 years old.The mean follow-up time was 17.61 months.The main pathologic types were stage I-II of MN(71.4%).The PLA₂R positive rate in kidney tissue was 78.9%,and it was 62.66% in serum (defined as the PLA₂R titer<20RU/ml).There were no significant differences in age,sex,baseline UTP and eGFR among the four groups(P>0.05).Compared with supportive treatment,remissionin of immunotherapy groups occurred earlier.The decline rate of UTP in the rituximab group was higher than tacrolimus group from 6 months,and the difference was significant at 30 month(μ_RTX=91.52%,μ_tacrolimus=75.52%,P<0.001).At 12 month and before,the increase rate of ALB was higher in the tacrolimus group.It had a significant difference in the two group at 18 month(μRTX=87.96%,μ_tacrolimus=66.98%,P<0.05).The decline rate of UTP in RTX group was lower than that in CTX group at 12 month and before.After 12 month,it was gradually higher in RTX group and showed a significant difference at 24 month(μ_RTX=93.45%,μ_CTX=64.48%,P<0.001).After 18 month,the eGFR in RTX group decreased by 0.63 ml/min.1.73m² compared with baseline data,while it decreased by 8.85, 7.78, 8.55 ml/min.1.73m² in tacrolimus, CTX, supportive group respectively.

Conclusion

Rituximab and tacrolimus,cyclophosphamide were all eutherapeutic.Tacrolimus group has better adherence.The efficacy of rituximab had no significant different with other regiments in short term,but the long-term efficacy was better and the kidney function was better protected.In addition,the incidence of adverse events was lower.Therefore,rituximab can be considered as one of the first options for the treatment of the PMN.