Introduction

Anomalies in β-cell played a role in the pathogenesis of membranous nephropathy. Hence, depletion of β-cell with rituximab may lead to inducing and maintaining a complete or partial remission of proteinuria in patients with this condition.

Methods

• Patients with membranous nephropathy, proteinuria of at least 5 g per 24 hours, and a quantified creatinine clearance of at least 40 ml per minute per 1.73 m² of body-surface area and had been receiving angiotensin-system blockade for at least 3 months were randomized to receive intravenous rituximab or oral cyclosporine.
• Patients were followed for 24 months.
• The primary outcome was a composite of complete or partial remission of proteinuria at 24 months. Laboratory variables and safety were also assessed.

Results

• The study included a total of 130 randomized patients.
• At 12 months, 60% patients (39 of 65 patients) in the rituximab group and 52% (34 of 65 patients) in the cyclosporine group has a complete or partial remission. At 24 months, 60% in the rituximab group while 20% in the cyclosporine showed complete or partial remission.
• Serious adverse events occurred in 11 patients in the rituximab group and in 20 patients in the cyclosporine group.

Conclusions

• Rituximab was non-inferior to cyclosporine in inducing complete or partial remission of proteinuria at 12 months.
• It was superior in maintaining proteinuria remission up to 24 months.

Reference

Fervenza FC, Appel GB, Barbour SJ, Rovin BH, Lafayette RA, Aslam N, et al. Rituximab or cyclosporine in the treatment of membranous nephropathy. N Engl J Med. 2019; 381: 36-46.