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Kidney Week

Abstract: SA-PO913

Personalized and Standard Treatment of Rituximab in Primary Membranous Nephropathy: A Prospective Multi-Center Trial in the East Coastal Region of China

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Xu, Yili, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Wang, Liang, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
  • Jiang, Chunming, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
  • Sun, Dong, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
  • Yang, Min, The First People's Hospital of Chang Zhou City, Changzhou, Jiangsu, China
  • Liu, Xiaobin, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
  • Wan, Cheng, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
  • Zhang, Bo, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Chen, Lianhua, The Affiliated Huai’an No.1 People's Hospital of Nanjing Medical University, Huai, Jiangsu, China
  • Zhang, Liyuan, The First People's Hospital of Lianyungang, Nanjing, China
  • Lu, Guoyuan, The First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
  • Liang, Zhang, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
  • Zhou, Hua, The First People's Hospital of Chang Zhou City, Changzhou, Jiangsu, China
  • Zhang, Xiaobo, The Affiliated Huai’an No.1 People's Hospital of Nanjing Medical University, Huai, Jiangsu, China
  • Zhou, Gang, Northern Jiangsu People's Hospital, Affiliated Hospital to Yangzhou University, Yangzhou, Jiangsu, China
  • Lu, Fang, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Zhang, Chengning, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Sun, Bin, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Zeng, Ming, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Shuaibo, Bian, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
  • Zhang, Li, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Shen, Lei, The First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
  • Yuan, Yanggang, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Xing, Chang Ying, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Mao, Huijuan, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Background

Guidelines recommend standard rituximab therapy (1000mg*2 or 375mg/m2*3-4) for patients with idiopathic membranous nephropathy (IMN) at high risk of progression to ESRD. This study assessed the safety and efficacy of B cell and anti-PLA2R antibody targeted low-dose rituximab therapy in patients with IMN.

Methods

In this prospective study, we compared the partial and complete remission, serious and non-serious events between the personalized treatment group and standardized protocols group. Patients were followed once every 2 months for 12 months. The primary outcome was a composite of complete or partial remission of proteinuria. In addition, laboratory indexes and safety were assessed.

Results

A total of 101 were available for statistical analysis out of 140 participants at inclusion. At 12 months, 34 out of 55 patients (61.8%) in the personalized group and 29 of 46 (63.04%) in the standardized group had complete or partial remission. Kaplan–Meier curves indicated no difference for the cumulative incidence of participants with IMN who progressed to the end point according to the two arms (Figure 2). The median (quartile) of total RTX dose at one year was 700 (600,1100) mg per patient with a total cost of RMB (yuan) 18786 (17388, 24378) per unit utility in the personalized group, which was markedly lower than that in the standardized group. Anti-PLA2R autoantibody depletion 6 months post-treatment could predict a higher probability of remission. There were statistically significant differences in the frequency of adverse events between groups (P=0.02).

Conclusion

B cell and anti-PLA2R antibody targeted rituximab therapy was as effective as standard protocols. It was a more economical and safer strategy for IMN patients.

Funding

  • Government Support – Non-U.S.