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Combination of rituximab and short-term glucocorticoids in the treatment of anti-phospholipase A2 receptor antibody positive idiopathic membranous nephropathy

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Abstract

Rituximab (RTX) has been the first option in idiopathic membranous nephropathy (IMN). However, the clinical effect was not very satisfactory. This study aimed to explore the clinical efficacy and safety of the combination of RTX and glucocorticoids (GC) in anti-phospholipase A2 receptor (anti-PLA2R) antibody positive IMN. Sixty-six patients were randomly divided into RTX/GC group (RTX infusion plus short-term oral GC) and RTX group (RTX infusion alone) in this prospective cohort study. Complete remission (CR) and partial remission (PR) were the primary outcomes. Adverse events were the secondary outcomes. The laboratory index including serum albumin, 24 h urinary protein, serum creatinine, estimated glomerular filtration rate, and anti-PLA2R antibody titer were also monitored. All patients were followed for at least 12 months. During the 12-month follow-up, the composite remission rates in RTX/GC and RTX groups were 74.3% and 67.7%, and the CR rates were 34.3% and 19.4%, respectively. The median time of remission in RTX/GC group was shorter than the RTX group (P < 0.001). Compared with RTX monotherapy, the combination of RTX and GC significantly decreased the anti-PLA2R antibody titer (P = 0.028). No significant difference was observed in the incidence of adverse events. The results of the Kaplan–Meier survival analysis indicated that the cumulative CR rate and cumulative composite remission rate in RTX/GC group were all better than the RTX group (P = 0.043, P = 0.040, respectively). The combination of RTX and GC was better than RTX monotherapy without increasing the adverse events in the treatment of IMN.

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Funding

This work was supported by the Key Clinical Research Project of the Second Affiliated Hospital of Nanchang University (No. 2022efyB01), the “Thousand Talents Plan” Project of Introducing and Training High‐level Talents of Innovation and Entrepreneurship in Jiangxi Province (No. JXSQ2023201030), and the Jiangxi Graduate Innovation Special Fund (No. YC2023-B090).

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  1. Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People’s Republic of China

    Qiqi Ma, Manna Li & Gaosi Xu

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  1. Qiqi Ma
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  2. Manna Li
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  3. Gaosi Xu
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QM conducted conception, design, data collection and manuscript writing. ML conducted data collection; GX was responsible for the idea, funds and paper revision. All authors approved the final version of the manuscript.

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Correspondence to Gaosi Xu.

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Ma, Q., Li, M. & Xu, G. Combination of rituximab and short-term glucocorticoids in the treatment of anti-phospholipase A2 receptor antibody positive idiopathic membranous nephropathy. Clin Exp Med 23, 5337–5343 (2023). https://doi.org/10.1007/s10238-023-01183-1

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