Efficacy And Safety Observation Of Rituximab For Refractory Idiopathic Membranous Nephropathy

ObjectiveIdiopathic membranous nephropathy(IMN)is one of the most important pathological types of primary nephrotic syndrome in adults,Refractory idiopathic membranous ephropathy(RIMN)is defined as the failure of an immunosuppressive regimen to induce a remission after at least 6 months of therapy which accounts for about 10%to 12%of patients with IMN.Rituximab had been shown to be effective in inducing remission of moderate and high-risk nephrotic syndrome in patients with IMN.This study retrospectively reviewed 33 RIMN patients who received rituximab therapy for efficacy and safety.MethodsThirty-three RIMN patients of the Nephrology Department of Qilu Hospital of Shandong University treated with rituximab from July 2018 to October 2021 were enrolled.All patients were followed up for at least 12 months.We analyzed and evaluated the clinical efficacy and adverse events of patients during the treatment.Results33 patients were treated with rituximab and the mean dose was 2636.4 ± 759.9 mg.72.73%of patients were in clinical remission,including complete remission in 15.5%of patients and partial remission in 57.58%of patients,and no patient relapsed.89.66%of patients with serum positive anti-phospholipase A2 receptor(PLA2R)antibody was turned negative in 3.2(1.5,4.5)months,and all of them were with the appearance of depletion or reduction as well as B-cell depletion.After 12 months of treatment,the median proteinuria declined from 6.8(3.9,12.0)g/24h to 2.9(0.9,4.3)g/24h(P<0.001)of all patients.The renal function of 30 patients remained stable and 3 progressed to end stage renal disease requiring renal replacement therapy.Over a follow-up time of 13.0(12.4,15.1)months,7(21.2%)adverse events occurred among 6 patients and no serious adverse events occurred.ConclusionsRituximab is a safe and effective treatment option for RIMN patients,even in those with severely damaged renal function.Rituximab can induce remission of nephrotic syndrome and maintain stabilization of renal function.Anti-PLA2R antibody may be used as a marker for individualized application in rituximab dosage and treatment monitoring.