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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1504646
This article is part of the Research Topic Targeted Immunotherapies for Autoimmune Diseases View all 5 articles

Efficacy Analysis of Rituximab in Treating Patients with Primary Membranous Nephropathy Dependent on Calcineurin Inhibitors

Provisionally accepted
Bing Chen Bing Chen 1*Zhuo Li Zhuo Li 1Tingting Zhao Tingting Zhao 2Sha-sha Zhang Sha-sha Zhang 3Jing Huang Jing Huang 4Honggang Wang Honggang Wang 5Yujiao Sun Yujiao Sun 1Rong Wang Rong Wang 1
  • 1 Shandong Provincial Hospital, Jinan, China
  • 2 Shandong Public Health Clinical Center, Jinan, Shandong Province, China
  • 3 Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, Shanghai Municipality, China
  • 4 Department of Nephrology, Jinan Shizhong People’s Hospital, Jinan, China, Jinan, Shandong Province, China
  • 5 The Second Hospital of Shandong University, Jinan, Shandong Province, China

The final, formatted version of the article will be published soon.

    Background: This study evaluated the efficacy of rituximab (RTX) in primary membranous nephropathy (PMN) patients with incomplete remission and drug dependence after long-term use of calmodulin inhibitors (CNIs). It aims for complete clinical and immunological remission, and cessation of CNI dependence.Methods: Thirty-six patients were enrolled in the study with two groups: drug-dependent and partial remission or immune non-remission group. Both groups underwent RTX therapy with gradual CNI tapering to end CNI dependency and induce complete remission.The primary outcome was overcoming CNI dependency and achieving complete remission after 12 months of RTX therapy. Secondary outcomes included immunological remission and recurrence rates.The drug-dependent group (20 patients) achieved significant proteinuria reduction compared to the partial remission or immune non-remission group (16 patients) (P=0.016).After 12 months of RTX treatment, all drug-dependent patients overcame CNI dependency (average withdrawal period: 5.3±3.7 months), with complete remission rates increased from 10% to 70.0% and complete immunological remission rates rose from 35.0% to 90.0%. In the partial remission or immune non-remission group, 14 patients discontinued CNI (average period: 4.6±4.5 months), with complete remission rates increasing from 5.0% to 68.8% and complete immunological remission rates from 6.3% to 68.8%. During follow-up, serum albumin increased, and anti-PLA2R antibodies, 24-hour proteinuria, and CD19 + cell numbers reduced, while creatinine remained stable. Three patients relapsed, four encountered adverse events, and no malignancies or other fatal adverse events were reported.PMN patients dependent on or partially responsive to long-term CNI therapy, reducing recurrence and minimizing prolonged immunosuppressive therapy risks.

    Keywords: Primary membranous nephropathy, rituximab, withdrawal drug rate, Clinical remission rate, immunologic remission rate

    Received: 01 Oct 2024; Accepted: 02 Dec 2024.

    Copyright: © 2024 Chen, Li, Zhao, Zhang, Huang, Wang, Sun and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Bing Chen, Shandong Provincial Hospital, Jinan, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.