Long-term real-world outcomes of rituximab in primary membranous nephropathy: a 154-patient cohort study from China

To investigate the long-term efficacy and safety of rituximab (RTX) in treating patients with primary membranous nephropathy (pMN), a total of 154 patients with pMN receiving RTX treatment were retrospectively enrolled in this study. The study included 92 patients who received RTX as an initial therapy, and 62 patients who received it as an alternative therapy. Over a median follow-up of 30.0 (24.0, 47.0) months after RTX treatment, 102/121 (84.3%) patients achieved immunological remission. And 128/154 (83.1%) patients achieved clinical remission (including 37.7% of CR and 45.5% of PR), accompanied by significant reduction in proteinuria and increase in serum albumin levels. Clinical response rates were comparable between the initial and alternative therapy groups (87.0 vs. 77.4%, p = 0.131), though patients in the alternative therapy group required a longer time to achieve remission. Among the 21 patients with eGFR < 60 mL·min−1·(1.73 m2)−1, 12 (57.1%) responded to RTX. Though two patients progressed to end-stage renal disease (ESRD) during follow-up, the remaining 19 patients showed an improvement in eGFR from 48.0 (38.0, 55.0) to 62.0 (36.0, 73.0) mL·min−1·(1.73 m2)−1. The clinical response in the RTX monotherapy group did not differ significantly from that in patients who received RTX in combination with glucocorticoids or other immunosuppressive agents. Twenty-eight patients experienced adverse events, most of which were mild and manageable. RTX, utilized as either an initial or alternative therapy, induced a significant clinical response in patients with pMN, including those with compromised renal function. These findings support RTX as an effective and well-tolerated option across various pMN patient profiles.