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Abstract: TH-PO1019

Rituximab in Primary Membranous Nephropathy Systematic Review and Meta Analysis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Alharbi, Laila, McMaster University, Hamilton, Ontario, Canada
  • Walsh, Michael, McMaster University, Hamilton, Ontario, Canada

Group or Team Name

  • Mike Walsh
Background

Primary membranous nephropathy is a kidney limited, autoimmune disease caused by circulating antibodies directed against phospholipase A2 receptor (PLA2R), a cell surface trans membrane receptor expressed on the surface of podocytes of the renal glomeruli. As our understanding of PMN has evolved and B cell played a major role in PMN, there has been paradigm shift in the treatment of PMN and Rituximab has emerged as a potential treatment.
Objectives: to assess the effects of Rituximab in primary membranous nephropathy

Methods

Search methods: we searched the following databases up to January 26, 2018: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Conferences organized by the following organizations: The American Society of Nephrology, Canadian Society of Nephrology, and International Society of Nephrology. We also search trial registries.
Selection criteria: We included randomized controlled trials and non-randomized studies with a minimum follow-up duration of 12 month that have investigated the effect of Rituximab compared to standard of care in patients diagnosed with PMN. We assessed the following outcomes: proteinuria remission, AntiPLAR2 depletion and adverse events.
Data collection and analysis: two reviewers independently extracted data from the included studies: The treatment effect (dichotomous variable) was assessed using risk ratio with 95% confidence intervals (CIs). We performed meta-analyses for 6 month and 12 month follow-ups.

Results

Main results: two randomized trials (202 participants) were included in the final analysis. At six month, RR 1.01(95% CI0.42 to 2.42) of proteinuria remission with rituximab compared to standard of care in PMN, and at twelve months RR 1.40, (95% CI 0.89 to 2.29). Additional data from three cohort studies showed RR 1.11(95% CI 0.70 to 1.76) of proteinuria remission with rituximab compared to standard of care in PMN at 12 months

Conclusion

conclusions: there is insufficient evidence to draw conclusions that rituximab is more effective with less adverse events than standard of care in primary membranous nephropathy. There is a need for further research in this area with larger sample size and longer term follow up.