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Low-dose rituximab is poorly effective in patients with primary membranous nephropathy
Gabriella Moroni1, Federica Depetri1, Lucia Del Vecchio2
1Nephrological Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Milano, Italy.
Background:
The optimal dosing and the efficacy of rituximab for primary membranous nephropathy (PMN) has not been established. This multicentric prospective study evaluates the efficacy and safety of low-dose rituximab (RTX) therapy in patients with PMN in clinical practice.
Methods:
Thirty-four consecutive patients with PMN and nephrotic syndrome were included and received RTX (375 mg/m2) once (18 patients) or twice (16 patients). RTX was the first-line therapy for 19 (56%) and the second line for 15 (44%) patients. All patients were followed for 12 months after RTX and 24 for at least 18 months (mean 23.9 ± 18.6 months).
Results:
At 12 months, 5 patients (14.7%) achieved complete response, 10 (29.4%) partial and 19 (55.8%) no response. Response occurred ∼6 months after RTX. At 24 months, the clinical situation was unchanged: two non-responders achieved partial response and two responders relapsed. Responders had significantly higher baseline GFR and lower anti-PLA2R antibodies compared with non-responders. Outcome was similar between one or two doses of RTX (non-responders 55.5 versus 56%, respectively) and between patients who had received previous therapy versus those receiving RTX as first-line therapy (non-responders 40 versus 68%, respectively). In the 15 patients already treated, the response to RTX was comparable to that of previous therapies.
Conclusion:
Low-dose RTX obtains remission in <50% of PMN patients. Probably, higher doses and longer treatments are needed to induce and maintain a response. The balance between the costs and benefits should guide the selection of the patient and the optimal dosage.
Insights
Low-dose rituximab (RTX) shows limited remission rates in primary membranous nephropathy (PMN). Further research is needed to determine optimal dosing and treatment duration for better efficacy in PMN patients.
Area of Science:
- Nephrology
- Immunology
- Pharmacology
Background:
- Efficacy and optimal dosing of rituximab (RTX) for primary membranous nephropathy (PMN) remain undetermined.
- This study prospectively evaluates low-dose RTX in PMN patients in a clinical setting.
Purpose of the Study:
- To assess the efficacy and safety of low-dose rituximab (RTX) for treating primary membranous nephropathy (PMN).
- To evaluate RTX as both first-line and second-line therapy in PMN patients.
Main Methods:
- A multicentric prospective study included 34 PMN patients with nephrotic syndrome.
- Patients received RTX (375 mg/m2) either once (18) or twice (16), with follow-up for 12-24 months.
Main Results:
- Complete or partial response was achieved in less than 50% of patients within 12 months.
- Response rates were similar for one or two RTX doses and comparable to previous therapies in pre-treated patients.
- Higher baseline GFR and lower anti-PLA2R antibodies were associated with better response.
Conclusions:
- Low-dose RTX achieves remission in fewer than 50% of PMN patients.
- Higher doses and longer treatment durations may be necessary for sustained response.
- Cost-benefit analysis should guide patient selection and dosage for RTX in PMN.
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