Kidney Week

Abstract: SA-PO0864

Emerging Monoclonal Therapies for Nephrotic Syndrome: A Systematic Review of Native and Post-Transplant Disease

Session Information

• Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
  October 24, 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

• Gharaei, Sophie, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Sophie Gharaei, MBChB

• Anwar, Sohail, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Sohail Anwar, MBBS

• Najmi, Vesta Shahriyar, SA Health, Adelaide, South Australia, Australia

Vesta Shahriyar Najmi, MBBS

• Kanigicherla, Durga Anil K., Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Durga Anil K. Kanigicherla, MD

Background

Idiopathic nephrotic syndrome (iNS - FSGS / MCD) can be a severe immune-mediated podocytopathy that may progress to treatment-resistant disease, kidney failure, and recurrence post-transplant with substantial risk of graft loss. Therapeutic options remain limited in refractory and recurrent disease. Emerging monoclonal therapies are being used in difficult-to-control cases, although the current evidence base remains fragmented and limited to small observational reports.

Methods

We performed a systematic review of studies published between 2011 and 2026 evaluating monoclonal antibody–based therapies in refractory iNS, including native kidney disease and recurrent post-transplant disease. Literature searches using Medline and Embase, screening, and data extraction were independently performed by two investigators. Eligible studies reported outcomes following treatment with OFA, OBI, or DARA in patients with refractory FSGS/MCD or post-transplant recurrence. Outcomes were categorised as complete remission (CR), partial remission (PR), or no remission (NR).

Results

18 studies comprising 53 patients were included. Most patients had prior treatment with rituximab (RTX) n=23, plasma exchange (PE) n=22, or multiple immunosuppressive regimens; 71% (n=37) were kidney transplant recipients with recurrent disease and 36 were paediatric patients.
OFA (n=23): CR was seen in 48%, PR in 35%, and NR in 17%; improved responses were observed in combination regimens involving prior PE or RTX.
OBI-based regimens (n=10): were associated with CR in 90% and PR in 10%; no treatment failures were reported. 8 patients were treated in combination with DARA.
DARA (n=20): was also associated with high response rates - 85% CR and 15% PR, including rescue of prior non-responders.

Conclusion

Targeted monoclonal antibody–based therapies demonstrate potential in refractory iNS and recurrent post-transplant FSGS. Across the reported studies, more targeted B-cell directed therapies, particularly OBI and DARA were associated with higher complete remission rates in difficult-to-treat disease. Prospective multicentre studies are needed to define optimal treatment sequencing, and biomarker-guided patient selection in iNS.