Abstract: FR-PO0822
Comparison of the Efficacy of Rituximab and Tacrolimus in Patients with High-Titer Phospholipase A2 Receptor (PLA2R) Antibody-Associated Membranous Nephropathy
Session Information
- Glomerular Clinical Trials: From Data to Impact
November 07, 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
- Wei, Xin, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Zeng, Honghui, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Zheng, Linfeng, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Yan, Yan, The First Affiliated Hospital of Nanchang University, Nanchang, China
Background
This study aimed to analyze the remission rate of rituximab and tacrolimus in patients with high-titer anti-PLA2R antibodies associated membranous nephropathy.
Methods
Patients diagnosed with membranous nephropathy by positive anti-PLA2R antibodies and the level >100 RU/ml at diagnosis, with or without renal biopsy, from January 2018 to April 2023, were enrolled. A total of 188 patients were enrolled according to different treatment regimens and were divided into the rituximab group (RTX group, n = 49), the tacrolimus group (TAC group, n = 102), and the rituximab combined with tacrolimus group (RTX+TAC group, n = 37). The clinical responses of the patients were analyzed.
Results
After 12 months of follow-up, 85.7% patients in the RTX group, 75.7%patients in the RTX+TAC group and 61.8% patients in the TAC group achieved total remission. During follow-up, 14.7% of patients in the TAC group developed end-stage renal disease, and survival curves showed significant differences in total and partial remission rates among the three groups (p=0.015)
Conclusion
Rituximab was superior to tacrolimus regarding total remission rate in patients with high-titer PLA2R antibody. These findings reinforce RTX's position as a first-line therapy for iMN, particularly advantageous for patients at high risk of disease progression.
Baseline characteristics of patients with high titer anti-PLA2R antibody IMN in three groups
| TAC（N=102） | RTX（N=49） | RTX+TAC (N=37) | P value | |
| Gender, male/female | 65/37 | 36/13 | 21/16 | 0.257 |
| Age, year | 57.83±12.38 | 54.39±15.88 | 52.89±13.82 | 0.114 |
| Level of anti，PLA2R Ab, RU/mL | 189.05（127.78，374.18） | 195.39（150.89，382.39） | 247.46（130.65，383.01） | 0.670 |
| Proteinuria, g/24h | 5.80（3.76，7.61） | 7.55（4.61，12.20） | 6.16（4.01，9.62） | 0.007 |
| eGFR, mL/min/1.73m2 | 78.34（62.75，98.91） | 71.93（53.23，98.48） | 74.76（55.83，74.76） | 0.408 |
eGFR: estimated glomerular filtration rate; RTX: Rituximab; TAC: Tacrolimus
Fig 1. Total Remission rate for iMN patients in three groups at 12M.