Wang YW, Wang XH, Wang HX, Yu RH. Successful treatment of patients with refractory idiopathic membranous nephropathy with low-dose Rituximab: A single-center experience. World J Clin Cases 2023; 11(3): 566-575 [PMID: 36793628 DOI: 10.12998/wjcc.v11.i3.566]
Corresponding Author of This Article
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
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 byNational 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
ARTICLE HIGHLIGHTS
Research 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 IMN patients with proven safety and efficacy.
Research motivation
RTX for the treatment of refractory IMN patients remains controversial and challenging.
Research objectives
To evaluate the efficacy and safety of a new low-dose RTX regimen for the treatment of refractory IMN patients.
Research methods
A retrospective study was performed on refractory IMN patients that accepted Low-dose RTX regimen (RTX, 200 mg, once a month for five months).
Research results
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.
Research conclusions
We found that our low-dose RTX regimen for the treatment of refractory IMN significantly improved clinical outcomes and further increased the remission rate.
Research perspectives
Treatment with our low-dose RTX regimen is more cost-effective than high-dose RTX.
