Obinutuzumab with Tacrolimus as a Bridge for Membranous Nephropathy
- Glomerular Diseases: Case Reports
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Trials
- Patel, Himanshu, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Jhaveri, Kenar D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Treatment of Membranous Nephropathy (MN) has been improving over the past several years. Obinutuzumab, a monoclonal antibody that targets CD20 on B-cells, is another potential therapeutic approach under investigation. Currently, Obinutuzumab is approved for the treatment of specific tumors such chronic lymphocytic leukemia.
We describe a 64-year-old male with a history of benign essential hypertension, stage 3a chronic kidney disease presenting with worsening proteinuria. Eight years prior to presentation, he was diagnosed with MN, and at that time, he was anti-Phospholipase A2 Receptor (PLA2R) antibody negative with 4gm of proteinuria. He was started on tacrolimus and got 1 year of treatment leading to remission. He relapsed months after stopping tacrolimus and his PLA2R antibody titers rose to 11 RU/mL with worsening proteinuria. He was started on cyclosporine and continued it for over 7 years and was discontinued a year before presentation. At the time of presentation, he had 3gm of proteinuria and was started on dapagliflozin and two infusions of rituximab with 1gm each two weeks apart with some initial allergic reaction but then completed the infusions without complications. A year later, he relapsed and PLA2R antibodies rose to 23.5 RU/mL and proteinuria of 11gm. He was given two infusions of Obinutuzumab with 1gm each two weeks apart given his sub-optimal prior response to rituximab and allergic reaction to the drug along with a tacrolimus bridge. His proteinuria improved to 2gm with serum a creatinine of 1.2mg/dL. He was taken off tacrolimus few months post Obinutuzumab treatment. He continues SGLT2i and ARB therapy as well.
Obinutuzumab is a more potent anti B cell agent that may be a promising therapy for MN. Using Obinutuzumab along with tacrolimus as a bridge to get the response of MN may serve as a potential long-term therapy for MN.