Kidney Week

Abstract: SA-PO0839

Long-Term Outcomes Following Combination Therapy of Rituximab, Low-Dosage Cyclophosphamide, and Prednisone for 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

• Aaron, Sydney, Massachusetts General Hospital, Boston, Massachusetts, United States

Sydney Aaron

• Seethapathy, Harish Shanthanu, Massachusetts General Hospital, Boston, Massachusetts, United States

Harish Shanthanu Seethapathy, MD, MBBS

• Jeyabalan, Anushya, Massachusetts General Hospital, Boston, Massachusetts, United States

Anushya Jeyabalan, MD

• Al Jurdi, Ayman, Massachusetts General Hospital, Boston, Massachusetts, United States

Ayman Al Jurdi, MD, FASN

• Sauvage, Gabriel, Massachusetts General Hospital, Boston, Massachusetts, United States

Gabriel Sauvage

• Chung, James L., Massachusetts General Hospital, Boston, Massachusetts, United States

James L. Chung, MA

• Zonozi, Reza, Nephrology Associates of Northern Virginia, Fairfax, Virginia, United States

Reza Zonozi, MD

• Laliberte, Karen A., Massachusetts General Hospital, Boston, Massachusetts, United States

Karen A. Laliberte, RN

• Niles, John, Massachusetts General Hospital, Boston, Massachusetts, United States

John Niles, MD

• Efe, Orhan, Massachusetts General Hospital, Boston, Massachusetts, United States

Orhan Efe, MD

Group or Team Name

• Vasculitis and Glomerulonephritis Center.

Background

Relapse remains a significant challenge in primary membranous nephropathy (MN). Combination of rituximab (RTX), low-dose oral cyclophosphamide (CYC), and prednisone has demonstrated promising efficacy, but longer-term outcomes and relapse risk need further investigation.

Methods

This is a single-center retrospective study of patients with MN who completed combination therapy with RTX x 2 years, low-dose CYC x 8 weeks, and short prednisone taper x 4 months at the Vasculitis and Glomerulonephritis Center at Mass General Hospital. Patients with >1 year follow-up after completing RTX were included. Primary outcome was relapse after complete or partial remission, defined as achieving UPCR <0.3 g/g with stable eGFR or UPCR <3.0 g/g with a ≥50% fall from baseline, respectively.

Results

66 patients were included. Patient characteristics are in Table 1. 32% (21/66) of patients had relapsing disease before combination therapy. 100% of patients achieved at least partial remission after combination therapy. During a median 4.3 (IQR 3.2-6.9) years of follow-up from last RTX, 18% (12/66) had a relapse. 92% (11/12) were anti-PLA2R positive. By Kaplan-Meier analysis, risk of relapse since final RTX was 3% at 2 years, 11% at 4 years, and 24% at 5 years (Fig.1). At relapse, median peak proteinuria was 3.7 (2.3-5.2) g/g. Following relapse, all 12 patients were retreated with RTX at median 5 infusions, including 5 who also received CYC and prednisone. All relapse patients achieved partial or complete remission. Of the 12 patients who relapsed, 33% (n=4) had at least 1 more subsequent relapse during B-cell repopulation, 1 of whom received combination therapy after prior relapse.

Conclusion

Risk of relapse is reduced by combination therapy for MN. Retreatment with RTX mono- or combination therapies is effective for relapsing disease.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025sb32662v