Abstract: SA-PO0853
Long-Term Comparative Effectiveness of Rituximab vs. Calcineurin Inhibitors for the Treatment of Membranous Nephropathy
Session Information
- Glomerular Management: Real-World Lessons and Emerging Therapies
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Gerety, Meghan, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Charu, Vivek, Stanford University School of Medicine, Stanford, California, United States
- Seewald, Nicholas J, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Glenn, Dorey A., The University of North Carolina at Chapel Hill Kidney Center, Chapel Hill, North Carolina, United States
- Schaubel, Douglas Earl, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Smith, Abigail R., Northwestern University Department of Preventive Medicine, Chicago, Illinois, United States
- Chen, Dhruti P., The University of North Carolina at Chapel Hill Kidney Center, Chapel Hill, North Carolina, United States
- Laurin, Louis-Philippe, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Holzman, Lawrence B., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Beck, Laurence H., Boston Medical Center, Boston, Massachusetts, United States
- Mariani, Laura H., University of Michigan Department of Internal Medicine, Ann Arbor, Michigan, United States
- Zee, Jarcy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background
Clinical trials in membranous nephropathy (MN) may establish treatment efficacy for short-term outcomes but are limited by small sample sizes and short study duration. This study applied modern statistical methods to CureGN data to compare effectiveness of rituximab (RTX) and calcineurin inhibitors (CNIs) for long-term MN outcomes.
Methods
MN participants initiating RTX or CNI 6+ months after any previous immunosuppressant (IST) exposure were eligible. Propensity scores (PS) based on demographics, labs, pathology, and comorbidities at treatment start were generated and PS-matching with exact matching on history of RTX and CNI was applied. Individuals were censored if they started a different IST during follow-up and inverse probability weights were used. Outcomes included time from treatment start to proteinuria remission, relapse following remission, and kidney disease progression. Hazard ratios (HR) were estimated from Cox models with variance adjustment to account for matching and multiple treatments within individuals. Differences in restricted mean survival time (RMST) were also estimated.
Results
331 treatment initiations across 254 unique participants were eligible, with median follow-up 53 months (IQR=26, 79). Participants on CNIs had significantly higher risks of disease progression (HR=2.83; 95% CI: 1.20, 6.68) than RTX. Proteinuria remission risks were similar in both groups (HR=0.97; 95% CI: 0.61, 1.52), though CNIs had higher risks of relapse (HR=2.14, 95% CI: 1.04, 4.40).
Conclusion
RTX was more effective for preserving eGFR than CNIs. Proteinuria remission and relapse results align with a prior clinical trial but extend trial results past 24 months. High-quality evidence on long-term treatment effectiveness in rare diseases can be generated from observational studies.