ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO654

Comparison of Outcomes Between Rituximab and Cyclophosphamide for Primary Membranous Nephropathy: A Single Center Experience

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Hussain, Azm Ul, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Sarween, Nadia, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
Background

Rituximab is increasingly being considered first-line treatment for Primary membranous nephropathy. While treatment outcomes have been compared to Calcineurin inhibitors there is no randomized controlled trial to date comparing Rituximab with a Cyclophosphamide-based regime. We aimed to review the outcomes of both treatments at our centre.

Methods

All patients with a diagnosis of Primary Membranous Nephropathy made between 2011 and 2020 were included in the study and identified through histology records. The follow-up period was until December 2021. Data were extracted from hospital electronic patient records. Secondary Membranous nephropathy and disease occurring in renal transplant recipients were excluded. Any patient who received Rituximab or cyclophosphamide were included and their clinical outcomes were compared. Complete remission was defined as a reduction in proteinuria to less than 300mg/day while the partial remission was defined as a reduction in proteinuria of ≥50 per cent from baseline and to >300 mg/day and <3.5 g/day. Statistical analysis was performed using Pearson-Chi square and One way ANOVA tests.

Results

50 patients were identified with a diagnosis of primary membranous nephropathy and received treatment with either or both Cyclophosphamide, and Rituximab. The mean age of participants was 53 years with 30% males, 72% (n=32) were PLA2R positive at the point of diagnosis. Response rates between the two treatment groups were not significantly different with 20% achieving full remission in Cyclophosphamide versus 17% in the Rituximab treated group (p = 0.40). There were significantly more partial remissions observed in the Cyclophosphamide versus Rituximab group (57% vs 24% respectively, p 0.003). Time to favourable response was shorter in the Cyclophosphamide versus Rituximab group (7 vs 12.6 months respectively, p = 0.003).

Conclusion

In our study, there is a suggestion that those treated with Cyclophosphamide versus Rituximab were more likely to respond to treatment. Patients treated with Rituximab also appear to take longer to respond. A trial comparing both treatments and reviewing short and long term responses is warranted.