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 X

Kidney Week

Abstract: SA-PO909

Monthly Mini-Dose Rituximab for Primary Membranous Nephropathy: A Different Approach

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Wang, Song, Peking University Third Hospital, Beijing, China
  • Deng, Zhenling, Peking University Third Hospital, Beijing, China
  • Zheng, Danxia, Peking University Third Hospital, Beijing, China
  • Zhou, Sijia, Peking University Third Hospital, Beijing, China
  • Bao, Wen-Han, Peking University Third Hospital, Beijing, China
  • Wang, Yue, Peking University Third Hospital, Beijing, China
Background

The currently recommended dose of rituximab for primary membranous nephropathy is as high as that for lymphoma. This study assessed the efficacy of monthly 100 mg rituximab monotherapy in patients with primary membranous nephropathy.

Methods

This retrospective study included 32 patients with primary membranous nephropathy treated at Peking University Third Hospital between March 2019 and January 2023. All patients were anti-phospholipase A2 receptor (PLA2R) antibody-positive and received rituximab 100 mg intravenously monthly for at least 3 months without other immunosuppressive therapy.

Results

The baseline parameters included: proteinuria, 8.5±3.6 g/day; serum albumin, 24.8±3.4 g/L; and anti-PLA2R antibody, 160 (20-2659) RU/mL. B-cell depletion was achieved in 87.5% patients after the first dose of rituximab 100 mg and in 100% after the second equivalent dose. The median follow-up was 24 months (range 18-38). Twenty-seven (84%) patients achieved remission, with 11 (34%) patients achieving complete remission by last follow-up. The relapse-free survival from the last infusion was 13.5 months (range 3-27). Patients were stratified into the low-titer (<150 RU/mL, n=17) and high-titer groups (≥150 RU/mL, n=15) based on the anti-PLA2R titer. Sex, age, urinary proteins, serum albumin, and estimated glomerular filtration rate at baseline did not differ significantly between the two groups. At 18 months, compared to the low-titer group, the rituximab dose (960±387 vs 694±270 mg, p=0.030) was higher, while serum albumin (37.0±5.4 vs 41.3±5.4 g/L, p=0.033) and the complete remission rate (13% vs 53%, p=0.000) were lower in the high-titer group.

Conclusion

Monthly rituximab 100 mg appeared as a potential effective regimen for treating anti-PLA2R-associated primary membranous nephropathy with a low anti-PLA2R titer.

Figure 2. clinical data between different anti-PLA2R titer groups before and after monthly mini-dose rituximab treatment.

Funding

  • Government Support – Non-U.S.