Obinutuzumab versus rituximab for the treatment of refractory primary membranous nephropathy

作者：Mingyue Xu, Yifeng Wang, MS Yuejin Wu, Ruiying Chen, Wenqian Zhao, Mingxin Li, Chuan‐Ming Hao, Qionghong Xie · 发表于：Nephrology Dialysis Transplantation · 年份：2024 · DOI：10.1093/ndt/gfae230 · 被引用次数：35 · 研究领域：Renal Diseases and Glomerulopathies、Vasculitis and related conditions、Pregnancy and Medication Impact

BACKGROUND: Rituximab has been shown effective in patients with primary membranous nephropathy refractory to glucocorticoids plus cyclophosphamide (GC + CTX) or calcineurin inhibitors (CNIs), but the response rates remain limited. Compared with rituximab, obinutuzumab is a humanized anti-CD20 monoclonal antibody with greater B-cell depletion capacity. This study was performed to investigate the effectiveness of obinutuzumab compared with rituximab in treating patients with refractory primary membranous nephropathy. METHODS: A retrospective study was conducted at Huashan Hospital, Fudan University between 1 January 2015 and 31 July 2024, and included adult patients with primary membranous nephropathy who met the following criteria: (i) resistance to GC + CTX and/or CNI regimens, (ii) dependence on CNIs or (iii) relapse within 1 year after CTX discontinuation. The patients subsequently received either obinutuzumab or rituximab. The primary endpoint was treatment response, which was defined as overall remission of nephrotic syndrome with no need for rescue therapy after obinutuzumab versus rituximab treatment. The secondary measures included immunological remission and safety profiles. RESULTS: Among the 51 participants, 20 received obinutuzumab and 31 received rituximab. The response rate was significantly greater in patients receiving obinutuzumab than in those receiving rituximab (90.0% vs 38.7%, P < .001) during a follow-up period of 24 [interquartile range (IQR) 10-34] mont...