Kidney Week

Abstract: TH-OR071

Early and Personalized Rituximab Treatment Preserves Kidney Function in Membranous Nephropathy

Session Information

• Glomerular Diseases: Epidemiology and Real-World Outcomes
  October 22, 2026 | Location: Room 501, Convention Center
  Abstract Time: 05:40 PM - 05:50 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Teisseyre, Maxime, Nice University Hospital, Nice, France

Maxime Teisseyre, MD, PhD

• Zorzi, Kévin, Nice University Hospital, Nice, France

Kévin Zorzi

• Brglez, Vesna, Nice University Hospital, Nice, France

Vesna Brglez, PhD

• Seitz-Polski, Barbara, Nice University Hospital, Nice, France

Barbara Seitz-Polski, MD, PhD

Group or Team Name

• the PMMN trial Investigators

Background

Membranous nephropathy (MN) is an autoimmune kidney disease mediated by autoantibodies, including those targeting the phospholipase A2 receptor (PLA2R1). Approximately one-third of patients progress to kidney failure. Epitope spreading across PLA2R1 domains is associated with a poorer renal prognosis. We previously demonstrated that an epitope spreading-guided rituximab regimen improves clinical remission at month-12 (doi: 10.1016/j.eclinm.2025.103648). Here, we assessed its impact on renal function at month-24.

Methods

Sixty-four patients from 12 French hospitals were randomly assigned to either a standard or a personalized rituximab regimen. In the standard arm, patients received six months of symptomatic treatment, followed, if nephrotic syndrome persisted, by two infusions of rituximab at 375 mg/m² at month-6. In the personalized arm, treatment was adapted according to the epitope spreading profile: patients without epitope spreading followed the standard protocol, whereas those with epitope spreading at baseline or at month-6 received an intensified regimen consisting of two 1,000 mg infusions.

Results

At month-24, renal function was significantly better preserved in the personalized arm. The relative change in estimated glomerular filtration rate (eGFR) from baseline to month-24 was -2.7% in the personalized group versus -14.5% in the standard group (p = 0.009), with a more favorable eGFR slope over time (p = 0.01, by least-squares regression). In multivariable analysis, treatment delay was the only factor independently associated with eGFR decline (p = 0.01). Clinical remission rates, the intensity of symptomatic treatment, and the cumulative anti-CD20 dose used for retreatment were comparable between the two groups.

Conclusion

Early and intensive rituximab treatment improves long-term renal outcomes, whereas delayed treatment, particularly in immunologically aggressive MN, is associated with greater renal function decline.

Acknowledgment

This work was sponsored by the Centre Hospitalier Universitaire de Nice (University Hospital of Nice). We thank all the medical, paramedical and technical staff implicated in patient care and laboratory analyses, both from the study coordinator site and from the centers who participated in the study.

eGFR slope over 24 months showed a significantly more favorable renal outcome in the personalized arm (p = 0.01, least-squares regression).

Funding

• Government Support – Non-U.S.