Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab

Area of Science:

• Nephrology
• Immunology
• Pharmacology

Background:

• Rituximab (RTX) is standard for membranous nephropathy (MN) but hard outcome data are limited.
• Understanding RTX's impact on end-stage kidney disease (ESKD) and eGFR decline is crucial.

Purpose of the Study:

• To evaluate RTX's efficacy in MN regarding hard renal outcomes.
• To assess long-term renal survival and factors influencing RTX response.

Main Methods:

• Retrospective study of 159 MN patients treated with RTX (2000-2022).
• Primary outcomes: ESKD and >50% eGFR loss. Secondary outcomes: remission rates (CR, PR, IR).
• Analysis of factors associated with treatment failure.

Main Results:

• 88.1% achieved complete or partial remission.
• Only 4.4% developed ESKD over a median 62.6-month follow-up.
• Estimated 5- and 10-year renal survival rates were 97% and 95.4% respectively.
• Previous immunosuppression and fibrosis predicted treatment failure.

Conclusions:

• RTX therapy is associated with excellent long-term renal survival in MN patients.
• Outcomes compare favorably to historical treatments like corticosteroids/cyclophosphamide.
• RTX is a valuable treatment option for MN, preserving kidney function long-term.