Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.566
Peer-review started: September 6, 2022
First decision: October 11, 2022
Revised: October 14, 2022
Accepted: December 15, 2022
Article in press: December 15, 2022
Published online: January 26, 2023
The recognition of idiopathic membranous nephropathy (IMN) as an autoimmune disease has paved the way for the use of B-cell depleting agents such as Rituximab (RTX), which is now a first-line drug for IMN patients with proven safety and efficacy.
RTX for the treatment of refractory IMN patients remains controversial and challenging.
To evaluate the efficacy and safety of a new low-dose RTX regimen for the treatment of refractory IMN patients.
A retrospective study was performed on refractory IMN patients that accepted Low-dose RTX regimen (RTX, 200 mg, once a month for five months).
A total of 9 refractory IMN patients were analyzed. At 12 mo of follow-up data from baseline, the 24 h urinary protein quantification was decreased from 8.14 ± 6.05 g/d to 1.24 ± 1.34 g/d (P < 0.05), and the albumin was improved from 28.06 ± 8.42 g/L to 40.93 ± 5.85 g/L (P < 0.01). Notably, after administering RTX for 6 mo, the serum creatinine decreased from 78.13 ± 16.49 μmol/L to 109.67 ± 40.87 μmol/L (P < 0.05). All of the 9 patients were serum anti-phospholipase A2 receptor (PLA2R) positive at the beginning, and 4 patients had a normal anti-PLA2R titer at six months. The level of CD19+ B-cells decreased to 0 at three months, and the count of CD19+ B-cells lasted to 0 until six months of follow-up.
We found that our low-dose RTX regimen for the treatment of refractory IMN significantly improved clinical outcomes and further increased the remission rate.
Treatment with our low-dose RTX regimen is more cost-effective than high-dose RTX.