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Obinutuzumab for membranous nephropathy: a systematic review using pooled case-level extraction analysis
İlker Atay1, Erhan Eroz1, Berfu Korucu1
1Division of Nephrology, Dokuz Eylul University, Izmir, Türkiye.
Background:
Obinutuzumab has increasingly been used in patients with PLA2R-associated membranous nephropathy (MN). However, reported outcomes vary substantially across studies due to heterogeneity in patient selection, response definitions, and follow-up duration. This study aimed to synthesize case-level extraction analysis to better characterize response patterns and factors influencing remission rates.
Methods:
MEDLINE, Web of Science, SCOPUS, and grey literature were systematically searched. Case-level extraction analysis from eligible case reports and case series were synthesized to evaluate clinical and immunological remission.
Results:
Eighty-nine patients from 19 publications were included. Most patients (64%) were reported from China. During a median follow-up of 12 months, overall clinical and immunological remission rates were 83% and 88.7%, respectively. Complete remission was numerically less frequent in patients refractory to prior immunosuppressive therapy compared with those who had previously responded (23.5% vs. 61.5%; nominal p = 0.012). Clinical remission appeared more common among patients followed for at least 12 months (92.6% vs. 75%; nominal p = 0.026). Geographic variation in reported outcomes was noted and appeared to be influenced by differences in follow-up duration and publication type. Adverse events were inconsistently reported; when reported, they were predominantly mild to moderate.
Conclusion:
This descriptive case-level extraction analysis is consistent with previous small series reporting relatively high clinical remission rates for obinutuzumab in PLA2R-associated MN. The observed remission rates may be influenced by prior treatment responsiveness and duration of follow-up.
Insights
Obinutuzumab shows high remission rates in PLA2R-associated membranous nephropathy (MN). Factors like prior treatment response and follow-up duration influence outcomes in this rare kidney disease.
Area of Science:
- Nephrology
- Immunology
- Pharmacology
Background:
- PLA2R-associated membranous nephropathy (MN) is increasingly treated with obinutuzumab.
- Existing studies report varied outcomes due to differences in patient selection, response definitions, and follow-up.
- A need exists to synthesize case-level data for a clearer understanding of obinutuzumab efficacy.
Purpose of the Study:
- To conduct a case-level extraction analysis of obinutuzumab in PLA2R-associated MN.
- To characterize response patterns and identify factors influencing remission rates.
Main Methods:
- Systematic literature search of MEDLINE, Web of Science, SCOPUS, and grey literature.
- Case-level data extraction from eligible case reports and series.
- Synthesis of data to evaluate clinical and immunological remission.
Main Results:
- Eighty-nine patients from 19 publications were included; 64% from China.
- Median follow-up was 12 months, with overall clinical and immunological remission rates of 83% and 88.7%.
- Higher complete remission in previously responsive patients (61.5% vs. 23.5%) and longer follow-up (≥12 months) correlated with better clinical remission (92.6% vs. 75%).
Conclusions:
- Case-level analysis confirms high clinical remission rates for obinutuzumab in PLA2R-associated MN.
- Prior treatment responsiveness and follow-up duration are key factors influencing remission.
- Observed geographic variations may stem from differing follow-up durations and publication types.
