Abstract: FR-PO0818
Sex-Specific Presentation and Response to Long-Term Rituximab in Phospholipase A2 Receptor (PLA2R)-Positive Membranous Nephropathy
Session Information
- Glomerular Diseases: Practice and New Concepts Shaping Modern Care
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Vargas-Brochero, Maria J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Falcao, Matheus Vieira, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Cara, Anila, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Juanet, Cristián, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Russo, Ilario, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Soler Romeo, Maria Jose, Hospital Infantil i l'Hospital de la Dona de Vall d'Hebron, Barcelona, CT, Spain
Background
PLA2R-positive membranous nephropathy (PLA2R-MN) is a heterogeneous autoimmune glomerular disease. Rituximab (RTX) is an effective therapy, but sex-specific differences in presentation and response remain unclear
Methods
We conducted a retrospective cohort study of patients with PLA2R-MN treated with RTX. Clinical characteristics, renal outcomes, and immunologic response (PLA2R antibodies and B-cell depletion) were compared by sex. Proteinuria and estimated glomerular filtration (eGFR) trajectories were analyzed using mixed-effects models. Time-to-event outcomes were assessed using Kaplan–Meier and Cox regression model
Results
Among 120 patients, 34 (28%) were female. At baseline, females had lower proteinuria (5.6 vs 9.4 g/24h, p < 0.001) and higher serum albumin (3.1 vs 2.5 g/dL, p < 0.001), with similar PLA2R antibody levels (81 vs 70 RU/mL, p = 0.64). RTX regimens were comparable. Females achieved complete remission earlier than males (median 29.9 vs 68.7 months; p=0.0004). Proteinuria declined similarly over time in both sexes. Higher RTX dose (>2 g) was associated with greater reductions in PLA2R levels (β = −0.53, p=0.017), independent of baseline, but did not affect time to B-cell depletion. Changes in eGFR were greater in females, reaching significance at 48 months (19.4 vs 7.7 mL/min/1.73 m2; p=0.039).During a median follow-up of 52.5 months, renal survival was high in both groups, with estimated survival of 95.7% at 60 months in males and 100% in females (log-rank p = 0.13).
Conclusion
Females with PLA2R-MN showed less severe disease at baseline and achieve earlier clinical remission after rituximab compared to males. However, immunologic responses, including reductions in PLA2R antibody levels and B-cell depletion, are similar across sexes. Higher rituximab doses are associated with greater antibody reduction but did not accelerates response. Changes in eGFR were greater in females, reaching statistical significance at 48 months, with a consistent trend toward higher eGFR over time despite comparable baseline values between sexes.Overall, females demonstrated more favorable clinical outcomes, although immunologic response to rituximab was similar across sexes