Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab
Introduction: Rituximab (RTX) therapy has become the standard of care for treatment of membranous nephropathy (MN). However, data on hard outcomes such as end-stage kidney disease (ESKD) and loss of estimated glomerular filtration rate (eGFR), are lacking. Methods: This was a retrospective study on...
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Elsevier
2025-08-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024925003158 |
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| author | Maria J. Vargas-Brochero Elisabeth Lafaut Yeshwanter Radhakrishnan Ilario Russo Sanjeev Sethi Ladan Zand Daniela Valencia Miriam Machado Maria Jose Soler Anila Cara Gian Marco Berti Daniel C. Cattran Fernando C. Fervenza |
| author_facet | Maria J. Vargas-Brochero Elisabeth Lafaut Yeshwanter Radhakrishnan Ilario Russo Sanjeev Sethi Ladan Zand Daniela Valencia Miriam Machado Maria Jose Soler Anila Cara Gian Marco Berti Daniel C. Cattran Fernando C. Fervenza |
| author_sort | Maria J. Vargas-Brochero |
| collection | DOAJ |
| description | Introduction: Rituximab (RTX) therapy has become the standard of care for treatment of membranous nephropathy (MN). However, data on hard outcomes such as end-stage kidney disease (ESKD) and loss of estimated glomerular filtration rate (eGFR), are lacking. Methods: This was a retrospective study on all patients with MN treated with RTX between January 2000 and December 2022. The primary outcomes were ESKD and eGFR loss > 50%. Clinical outcomes were complete remission (CR), partial remission (PR) (reduction in baseline proteinuria ≥ 50% and proteinuria ≤ 3.5 g/24 h), and immunological remission (IR) (serum antiphospholipase A receptor antibody [PLA2R-Ab] depletion). Results: A total of 159 patients were included (75.5% male, 87.4% White, median age: 58 years); 52.8% had previous immunosuppression (IS). Baseline serum creatinine was 1.50 (1.1–1.9) mg/dl, eGFR was 54.6 (37.4–72.5) ml/min per 1.73 m2, proteinuria was 9.2 (6.7–11.9) g/24 h, and serum albumin was 2.7 (2.2–3.2) g/dl; Of the patients, 108 (75.5%) had PLA2R-Ab–associated MN (PLA2R-MN); and 140 of 159 (88.1%) attained CR or PR. Median (interquartile range [IQR]) time to CR and PR were 22.6 (15.5–37.4) and 6.8 (3.6–12.1) months, respectively. Failure to respond to RTX was observed in 11.9% of patients. Previous IS and interstitial fibrosis/tubular atrophy (IFTA) ≥ 25% were independent factors associated with failure to respond to RTX. Patients treated only with RTX with a median follow-up of 62.6 months; 7 of 159 (4.4%) developed ESKD with an estimated renal survival of 97% (95% confidence interval [CI]: 94%–100%) and 95.4% (95% CI: 91.2%–99%) at 5 and 10 years, respectively. Conclusion: RTX treatment is associated with excellent long-term renal survival that compares favorably with historical survival rates using the cyclic corticosteroids/cyclophosphamide regimen. |
| format | Article |
| id | doaj-art-a78c3b8db44f4dc09152ed7be4f9ad11 |
| institution | Kabale University |
| issn | 2468-0249 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-a78c3b8db44f4dc09152ed7be4f9ad112025-08-20T03:33:31ZengElsevierKidney International Reports2468-02492025-08-011082630264110.1016/j.ekir.2025.05.013Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With RituximabMaria J. Vargas-Brochero0Elisabeth Lafaut1Yeshwanter Radhakrishnan2Ilario Russo3Sanjeev Sethi4Ladan Zand5Daniela Valencia6Miriam Machado7Maria Jose Soler8Anila Cara9Gian Marco Berti10Daniel C. Cattran11Fernando C. Fervenza12Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADepartment of Internal Medicine, Ghent University, Ghent, BelgiumDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, ItalyDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADepartment of Nephrology, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Research, Barcelona, SpainDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology, University of Toronto, Ontario, CanadaDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Correspondence: Fernando C. Fervenza, Division of Nephrology and Hypertension, 200 1st Street SW, Mayo Clinic, Rochester, Minnesota 55905, USA.Introduction: Rituximab (RTX) therapy has become the standard of care for treatment of membranous nephropathy (MN). However, data on hard outcomes such as end-stage kidney disease (ESKD) and loss of estimated glomerular filtration rate (eGFR), are lacking. Methods: This was a retrospective study on all patients with MN treated with RTX between January 2000 and December 2022. The primary outcomes were ESKD and eGFR loss > 50%. Clinical outcomes were complete remission (CR), partial remission (PR) (reduction in baseline proteinuria ≥ 50% and proteinuria ≤ 3.5 g/24 h), and immunological remission (IR) (serum antiphospholipase A receptor antibody [PLA2R-Ab] depletion). Results: A total of 159 patients were included (75.5% male, 87.4% White, median age: 58 years); 52.8% had previous immunosuppression (IS). Baseline serum creatinine was 1.50 (1.1–1.9) mg/dl, eGFR was 54.6 (37.4–72.5) ml/min per 1.73 m2, proteinuria was 9.2 (6.7–11.9) g/24 h, and serum albumin was 2.7 (2.2–3.2) g/dl; Of the patients, 108 (75.5%) had PLA2R-Ab–associated MN (PLA2R-MN); and 140 of 159 (88.1%) attained CR or PR. Median (interquartile range [IQR]) time to CR and PR were 22.6 (15.5–37.4) and 6.8 (3.6–12.1) months, respectively. Failure to respond to RTX was observed in 11.9% of patients. Previous IS and interstitial fibrosis/tubular atrophy (IFTA) ≥ 25% were independent factors associated with failure to respond to RTX. Patients treated only with RTX with a median follow-up of 62.6 months; 7 of 159 (4.4%) developed ESKD with an estimated renal survival of 97% (95% confidence interval [CI]: 94%–100%) and 95.4% (95% CI: 91.2%–99%) at 5 and 10 years, respectively. Conclusion: RTX treatment is associated with excellent long-term renal survival that compares favorably with historical survival rates using the cyclic corticosteroids/cyclophosphamide regimen.http://www.sciencedirect.com/science/article/pii/S2468024925003158long-term outcomemembranous nephropathyremissionrituximab |
| spellingShingle | Maria J. Vargas-Brochero Elisabeth Lafaut Yeshwanter Radhakrishnan Ilario Russo Sanjeev Sethi Ladan Zand Daniela Valencia Miriam Machado Maria Jose Soler Anila Cara Gian Marco Berti Daniel C. Cattran Fernando C. Fervenza Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab Kidney International Reports long-term outcome membranous nephropathy remission rituximab |
| title | Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab |
| title_full | Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab |
| title_fullStr | Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab |
| title_full_unstemmed | Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab |
| title_short | Long-term Outcome of Adult Patients With Membranous Nephropathy Treated With Rituximab |
| title_sort | long term outcome of adult patients with membranous nephropathy treated with rituximab |
| topic | long-term outcome membranous nephropathy remission rituximab |
| url | http://www.sciencedirect.com/science/article/pii/S2468024925003158 |
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