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Abstract: FR-PO872

Remission and Relapse Rates for Primary Membranous Nephropathy Treated with Combination Rituximab, Cyclophosphamide, and Prednisone

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Zonozi, Reza, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Laliberte, Karen A., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Rosenthal, Jillian, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Huizenga, Noah, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Dowst, Sarah, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Cortazar, Frank B., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Niles, John, Massachusetts General Hospital, Boston, Massachusetts, United States
Background

We evaluated the efficacy of combination therapy with rituximab-induced continuous B cell depletion, a short course of low-dose, oral cyclophosphamide, and an accelerated prednisone taper (RCP) for the treatment of primary membranous nephropathy.

Methods

A retrospective analysis was conducted on 49 consecutive patients with primary membranous nephropathy treated with RCP at Massachusetts General Hospital. The co-primary outcomes were attainment of partial (PR) and complete remission (CR). PR was defined as a urinary protein to creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline. CR was defined as a UPCR < 0.3 g/g. Secondary outcomes were SAEs and change in proteinuria, serum creatinine and albumin after 1 year of treatment. Relapse was defined as a UPCR > 3 g/g after having achieved CR or PR.

Results

Over a median follow-up of 36 (IQR 24 - 56) months, 100% of patients achieved PR and 82% of patients achieved CR at a median time of 3.4 and 13.1 months, respectively. After 1 year of treatment, median (IQR) UPCR declined from 8.2 (5.2 - 10.7) to 0.3 (0.2 - 0.7) g/g (P < 0.001). Fourteen SAEs occurred over 166 patient-years. One patient (2%) progressed to ESRD, and no patients died. Of those patients followed after B cell return (n = 25), only 1 patient relapsed over a median follow-up of 18 (IQR 6.2 - 37) months.

Conclusion

Treatment of primary membranous nephropathy with RCP resulted in high rates of complete remission and relapse-free survival.

Baseline characteristics

Funding

  • NIDDK Support