Evaluating rituximab against cyclophosphamide or cyclosporine in idiopathic membranous nephropathy: a meta-analysis

Idiopathic membranous nephropathy (IMN) is a common cause of nephrotic syndrome in adults. While cyclophosphamide and cyclosporine are established treatments, rituximab has emerged as a promising alternative. This meta-analysis aims to compare the efficacy of rituximab versus cyclophosphamide and cyclosporine in patients with IMN.

A meta-analysis was conducted in accordance with PRISMA guidelines. Databases including PubMed, EMBASE, Cochrane and Web of Science were searched for randomized controlled trials and observational studies comparing rituximab to cyclophosphamide or cyclosporine in adults with biopsy-confirmed IMN. The primary outcome was treatment efficacy (complete or partial remission). Risk of bias was assessed using the Cochrane RoB 2.0 tool. A random-effects model was used for pooling risk ratios. P < 0.05 was considered statistically significant. R software (4.5.0) was used to perform statistical analysis.

A total of eight studies comprising 936 patients were included in the meta-analysis. Rituximab was compared with cyclophosphamide or cyclosporine in idiopathic membranous nephropathy. The overall pooled analysis showed no significant difference in efficacy between treatment groups (RR = 1.117, 95% CI 0.882-1.414, P = 0.3595). Sensitivity analysis confirmed the robustness of the results. Subgroup analysis revealed that rituximab was more effective than cyclosporine in Asian populations, but less effective than cyclophosphamide in patients with severe renal dysfunction. No significant difference in severe adverse events (RR = 0.984, 95% CI 0.744-1.302, P > 0.05) was found between treatments.

Rituximab is comparable in efficacy to cyclophosphamide and cyclosporine for IMN treatment, with no significant difference in remission rates or severe adverse events. Treatment should be individualized.