Kidney Week

Abstract: TH-PO592

Long-Term Outcome of Adult Patients with Membranous Nephropathy Treated with Rituximab

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

• Vargas-Brochero, Maria Jose, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Maria Jose Vargas-Brochero, MD, MS, MSc

• Radhakrishnan, Yeshwanter, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Yeshwanter Radhakrishnan, MBBS

• Lafaut, Elisabeth P., Universiteit Gent Faculteit Geneeskunde en Gezondheidswetenschappen, Gent, Belgium

Elisabeth P. Lafaut, MD

• Valencia-Morales, Nancy Daniela, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Nancy Daniela Valencia-Morales, MD

• Machado, Miriam, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Miriam Machado, MD

• Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Ladan Zand, MD

• Sethi, Sanjeev, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Sanjeev Sethi, MD, PhD

• Soler, Maria Jose, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain

Maria Jose Soler, MD, PhD

• Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Fernando C. Fervenza, MD, PhD, FASN

Background

Rituximab (RTX) has become the cornerstone treatment of membranous nephropathy (MN). However,data on hard outcome such as eGFR and progression to end-stage kidney disease (ESKD) are lacking.

Methods

Retrospective cohort study was conducted on MN patients and treated with RTX from January 2000 through December 2022.Clinical outcome were complete remission (CR) [proteinuria ≤0.3 g/24h and serum albumin ≥3.5 g/dl], partial remission (PR)[baseline proteinuria reduction≥50% and proteinuria ≤3.5 g/24h], reduction proteinuria (RP)[baselineproteinuria reduction≥50%], and development of ESKD. Immunological remission (IR) was defined as negative serum PLA2R-Ab.

Results

90 patients included, 72(80%) were male, and 81(90%)white, with a mean (SD) age of 56.5(14.2) years at RTX initiation. Previous immunosuppression used in 45(50%). Baseline median[IQR]serum creatinine was 1.4 mg/dl [1.09-1.90], albumin 2.8 g/dl [2.2-3.4], and proteinuria 9 g/24h [6.2-11.2]. Nephrotic syndrome was present in 78.9%(71) patients. PLA2R Ab status in serum and/or kidney biopsy was available in 80 (88.9%) and positive in 61 (76.3%) patients. Mean (SE) survival was 17(0.72) years. 87 patients reached clinical response (CR, PR or RP) after a median [IQR] of 6.3 [4.8, 14.8] months. Median [IQR] time to first CR and PR was 21.6[11.8, 41.8] and 6.1[4.3, 13.8] months. Median time to IR was 4.79[95% CI 3.78, 6.34]months. ESKD developed in 3(3.3%) patients. Estimated ESKD-free survival was 100% at 5 years and 96.9% at 10 years.

Conclusion

RTX on MN patients is associated with an excellent long-term renal survival,that compares favorably with historical survival rates using the cyclic corticosteroids/cyclophosphamide regimen.