Obinutuzumab versus rituximab in refractory membranous nephropathy: a single-center retrospective cohort study

作者：Wen-Hui Lei, Hai-ping Lai, Yihui Lv, Lie Jin, Jun Xin · 发表于：BMC Nephrology · 年份：2026 · DOI：10.1186/s12882-026-04932-y · 被引用次数：1 · 研究领域：Medicine

Refractory membranous nephropathy (MN) remains challenging. We aim to compare the efficacy and safety of obinutuzumab versus rituximab in adults with refractory or relapsing MN, using a retrospective, single-center study design. This retrospective, single-center cohort study was conducted at the Fifth Affiliated Hospital of Wenzhou Medical University from January 2022 to January 2025. Eleven patients received obinutuzumab, and twenty-two matched controls received rituximab after propensity score matching (1:2). Inclusion criteria were biopsy-confirmed primary MN, age between 18 and 80 years, and a diagnosis of refractory disease. The primary endpoints were a composite measure of treatment response (including partial remission [PR] and complete remission [CR]); secondary endpoints included immunological remission and safety. Kaplan-Meier analyses were used to estimate time to response and time to CR; log-rank tests compared groups. Multivariate Cox regression identified factors associated with response. Baseline characteristics were balanced. Obinutuzumab achieved higher overall response and CR rates (log-rank p = 0.0074 and p = 0.012, respectively). At 18 months, CR was 54.6% with obinutuzumab versus 9.1% with rituximab (p = 0.024). Obinutuzumab induced prolonged B cell depletion and faster attainment of immunological remission (anti-PLA2R < 14 RU/mL). Improvements in serum albumin and 24-hour proteinuria favored obinutuzumab at 6–12 months (p < 0.05). Safety was comparable b...