Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2023; 11(3): 566-575
Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.566
Successful treatment of patients with refractory idiopathic membranous nephropathy with low-dose Rituximab: A single-center experience
Yao-Wei Wang, Xin-Hui Wang, Hong-Xia Wang, Ren-Huan Yu
Yao-Wei Wang, Xin-Hui Wang, Hong-Xia Wang, Ren-Huan Yu, China Department of Nephrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
Author contributions: Wang HX and Wang YW contributed to the conception and design of the study; Wang HX, Wang YW, and Wang XH contributed to data collection, analysis, and interpretation; Wang YW and Wang XH wrote the manuscript; Yu RH critically revised the manuscript for important intellectual content; All authors revised the manuscript and approved the submitted version.
Supported by National Key Research and Development Program of China, No. 2019YFC1708503.
Institutional review board statement: The study protocol was approved by the ethics review board of Xiyuan Hospital, China’s Academy of Chinese Medical Sciences (Beijing, China, approved No. 2022XLA130-2). All of the procedures were performed in accordance with the Declaration of Helsinki and relevant policies in China.
Informed consent statement: A written informed consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ren-Huan Yu, PhD, Professor, China Department of Nephrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No. 1 Xiyuan Playground, Haidian District, Beijing 100091, China. tezhongeyu@vip.sina.com
Received: September 6, 2022
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
Processing time: 142 Days and 10.9 Hours
Abstract
BACKGROUND

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 treating IMN with proven safety and efficacy. Nevertheless, the usage of RTX for the treatment of refractory IMN remains controversial and challenging.

AIM

To evaluate the efficacy and safety of a new low-dose RTX regimen for the treatment of patients with refractory IMN.

METHODS

A retrospective study was performed on refractory IMN patients that accepted a low-dose RTX regimen (RTX, 200 mg, once a month for five months) in the Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences’ Department of Nephrology from October 2019 to December 2021. To assess the clinical and immune remission data, we performed a 24 h urinary protein quantification (UTP) test and measured the serum albumin (ALB) and serum creatinine (SCr) levels, phospholipase A2 receptor (PLA2R) antibody titer, and CD19+ B-cell count every three months.

RESULTS

A total of nine refractory IMN patients were analyzed. During follow-up conducted twelve months later, the results from the 24 h UTP decreased from baseline [8.14 ± 6.05 g/d to 1.24 ± 1.34 g/d (P < 0.05)] and the ALB levels increased from baseline [28.06 ± 8.42 g/L to 40.93 ± 5.85 g/L (P < 0.01)]. Notably, after administering RTX for six months, the SCr decreased from 78.13 ± 16.49 μmol/L to 109.67 ± 40.87 μmol/L (P < 0.05). All of the nine patients were positive for serum anti-PLA2R at the beginning, and four patients had normal anti-PLA2R titer levels at six months. The level of CD19+ B-cells decreased to 0 at three months, and CD19+ B-cell count remained at 0 up until six months of follow-up.

CONCLUSION

Our low-dose RTX regimen appears to be a promising treatment strategy for refractory IMN.

Keywords: Refractory nephrotic syndrome; Idiopathic membranous nephropathy; Low-dose rituximab

Core Tip: According to the Kidney Disease Improving Global Outcomes 2021 guidelines, Rituximab (RTX) is now the first-line therapy for patients with idiopathic membranous nephropathy (IMN). However, the use of RTX for the treatment of patients with refractory IMN remains challenging. We conducted a retrospective study on nine patients with refractory IMN to explore the efficacy and safety of a new low-dose RTX regimen (RTX, 200 mg, once a month for five months), and conclude that our low-dose RTX regimen is a promising treatment strategy for refractory IMN.