Obinutuzumab for membranous nephropathy: a systematic review using pooled case-level extraction analysis.

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.