Rituximab for the treatment of membranous nephropathy: a single-center experience

Rigler, A; Jerman, Alexander; Orsag, Alesa; Kojc, Nika; Kovač, Damjan; Škoberne, Andrej; Borštnar, Špela; Haler, Željka Večerić; Avguštin, Nuša; Kveder, Radoslav; Ferluga, D; Vizjak, Alenka; Lindič, Jelka

doi:10.5414/cnp88fx07

Cited by 7 publications

(12 citation statements)

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“…In the randomized controlled trial from Dahan et al [49] Heterogeneity: Tau 2 = 0.29; χ 2 = 5.34, df = 2 (p = 0.07); I 2 = 63% Test for overall effect: Z = 0.57 (p = 0.57) A B C of CR or PR was 35% in the primary 6-month endpoint, but after an extended median follow-up of 17 months, 64.9% of rituximab-treated patients were in remission. In the prospective study from Aleš Rigler et al [27], the remission rate was 37.9% following rituximab treatment. They attributed the results to a short follow-up period and low dose of rituximab.…”

Section: Discussionmentioning

confidence: 94%

“…Table I displays the basic characteristics of the included reports. There were 2 retrospective reports [26,27] and 12 prospective reports [28][29][30][31][32][33][34][35][36][37][38][39]. There are many administration protocols for rituximab, including four weekly doses of 375 mg/m 2 (the most common), 15 days part of 1 g and titrated to circulating B cells.…”

Section: Search Resultsmentioning

confidence: 99%

“…Patient characteristics of 17 studies are shown in Table II. Based on baseline proteinuria, no studies were classified as low-risk, three studies [26,27,31] were included in the mediumrisk group, and twelve studies [28][29][30][32][33][34][35][36][37][38][39] were classified as high-risk. Seven studies [27-29, 32, 34-36] reported that rituximab was administered in four weekly rituximab doses of 375 mg/m 2 .…”

Section: Search Resultsmentioning

confidence: 99%

“…The pooled OR of initial results was 1.38 (95% CI: 1.12-1.71; p = 0.003; Figure 2 A), and after conversion, the pooled OR of overall PR and CR remission rate was 0.58 (95% CI: 0.53-0.63; p = 0.003), which was statistically significant. The baseline proteinuria of three studies [26,27,31] met criteria of the medium-risk group. The I 2 = 63%, a random model, indicated heterogeneity of 1.25 (95% CI: 0.58-2.72; p = 0.57; Figure 2 B) between the included studies.…”

Section: Efficacy Of Rituximab In Membranous Nephropathymentioning

confidence: 99%

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Clinical efficacy and safety of rituximab with membranous nephropathy: a meta-analysis

Zhong

Zhou

et al. 2020

Arch Med Sci

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Introduction: Membranous nephropathy (MN) is an organ-specific autoimmune disease, and its prevalence is increasing. B lymphocytes activated by T cells produce antibodies. CD19+/CD20+ plasma cells may contribute to autoantibody and alloantibody production. Rituximab has been effective in treating MN in many clinical trials. Thus, we conducted a meta-analysis to explore the clinical efficacy and safety of rituximab with MN. Material and methods: We searched Embase, PubMed, Cochrane Library and ClinicalTrials.gov without language or publication date limitations. Studies were classified in high-risk, medium-risk and low-risk groups based on baseline proteinuria. Follow-up periods and different administrations of rituximab were also compared. Complete remission (CR) and partial remission (PR) were assessed to measure the efficacy of rituximab, and adverse effects were also extracted. Dichotomous data were expressed by the odds ratio (OR), and the 95% confidence intervals (95% CI) were used for the recruited studies. Results: Fourteen articles, including 17 studies, were included in this metaanalysis. The pooled OR of overall PR and CR remission rate was 0.58 (95% CI: 0.53-0.63; p = 0.003). No studies belonged to the low-risk group. The overall PR and CR remission rate in the medium-risk group was 0.56 (95% CI: 0.36-0.73; p = 0.57). The pooled OR of overall PR and CR remission rate in the high-risk group was 0.59 (95% CI: 0.53-0.65; p = 0.03). At the 12-month follow-up, the pooled OR of overall PR and CR remission rate was 0.51 (95% CI: 0.43-0.59; p = 0.72). At the 24-month follow-up, the pooled OR of overall PR and CR remission rate was 0.71 (95% CI: 0.48-0.86; p = 0.07). The pooled OR of efficacy of rituximab at 375 mg/m 2 × 4 was 0.63 (95% CI: 0.55-0.70; p = 0.001). Rituximab was tolerated in MN, and most adverse effects were mild. The pooled OR of infusion reaction rate of rituximab was 0.25 (95% CI: 0.13-0.44; p = 0.01) in MN. The pooled OR of cardiovascular-related event rate of rituximab in MN was 0.04 (95% CI: 0.02-0.11). The pooled OR of infection rate of rituximab in MN was 0.06 (95% CI: 0.03-0.12; p < 0.00001). Conclusions: Rituximab is safe and effective in MN and a promising alternative treatment. More randomized control trials and studies on the role of MN are expected.

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Section: Discussionmentioning

confidence: 94%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Efficacy Of Rituximab In Membranous Nephropathymentioning

confidence: 99%

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Clinical efficacy and safety of rituximab with membranous nephropathy: a meta-analysis

Zhong

Zhou

et al. 2020

Arch Med Sci

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“…Some authors suggest that depletion of peripheral B cells could be insufficient to ensure sustained remission; therefore higher doses and longer treatment duration could be considered when RTX is used to prevent the relapses [ 177 , 178 ].…”

Section: Treatment Of Mn: Current Controversiesmentioning

confidence: 99%

Membranous Nephropathy and Anti-Podocytes Antibodies: Implications for the Diagnostic Workup and Disease Management

Pozdzik

Brochériou

David

et al. 2018

BioMed Research International

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The discovery of circulating antibodies specific for native podocyte antigens has transformed the diagnostic workup and greatly improved management of idiopathic membranous nephropathy (iMN). In addition, their identification has clearly characterized iMN as a largely autoimmune disorder. Anti-PLA2R1 antibodies are detected in approximately 70% to 80% and anti-THSD7A antibodies in only 2% of adult patients with iMN. The presence of anti-THSD7A antibodies is associated with increased risk of malignancy. The assessment of PLA2R1 and THSD7A antigen expression in glomerular immune deposits has a better sensitivity than measurement of the corresponding autoantibodies. Therefore, in the presence of circulating anti-podocytes autoantibodies and/or enhanced expression of PLA2R1 and THSD7A antigens MN should be considered as primary MN (pMN). Anti-PLA2R1 or anti-THSD7A autoantibodies have been proposed as biomarkers of autoimmune disease activity and their blood levels should be regularly monitored in pMN to evaluate disease activity and predict outcomes. We propose a revised clinical workup flow for patients with MN that recommends assessment of kidney biopsy for PLA2R1 and THSD7A antigen expression, screening for circulating anti-podocytes antibodies, and assessment for secondary causes, especially cancer, in patients with THSD7A antibodies. Persistence of anti-podocyte antibodies for 6 months or their increase in association with nephrotic proteinuria should lead to the introduction of immunosuppressive therapies. Recent data have reported the efficacy and safety of new specific therapies targeting B cells (anti-CD20 antibodies, inhibitors of proteasome) in pMN which should lead to an update of currently outdated treatment guidelines.

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Rituximab for the management of idiopathic membranous nephropathy: a meta-analysis

et al. 2020

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Rituximab for the treatment of membranous nephropathy: a single-center experience

Cited by 7 publications

References 0 publications

Clinical efficacy and safety of rituximab with membranous nephropathy: a meta-analysis

Clinical efficacy and safety of rituximab with membranous nephropathy: a meta-analysis

Membranous Nephropathy and Anti-Podocytes Antibodies: Implications for the Diagnostic Workup and Disease Management

Rituximab for the management of idiopathic membranous nephropathy: a meta-analysis

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