Successful treatment of patients with refractory idiopathic membranous nephropathy with low-dose Rituximab: A single-center experience

Table 1 Baseline characteristics

Patient No.	Age (yr)	Sex	PLA2R	Duration (mo)	Previous treatment	Effect	Side effect	Current treatment
1	57	M	+	12	(1) RTX 500 mg iv twice in two months; and (2) Pre 40 mg/d + CSA 150 mg/d	SR	Serum glucose up	Pre + TAC
2	28	M	+	54	(1) Pre 20 mg/d + TAC 2 mg/d; and (2) Pre 24 mg/d + TAC 2 mg/d	SR	Cushing’s syndrome	Pre + TAC
3	40	M	+	21	(1) CSA 150 mg/d; (2) Pre 20 mg/d + CTX 100 mg/d; and (3) Pre 30 mg + TAC 2 mg/d	SR	Hypertension	Pre + TAC
4	60	F	+	51	(1) TAC 2 mg/d; and (2) Pre 20 mg + CSA 150 mg/d	SR	Steroid-induced diabetes	Non
5	31	M	+	9	(1) CsA 150 mg/d; (2) Pre 48 mg/d + TAC 2 mg/d; and (3) Pre 48 mg/d + CTX 100 mg/d	SD	Steroid-induced diabetes; liver damage; Hypertension	Pre + TAC
6	29	F	+	31	(1) Pre 15 mg/d + CSA 150 mg/d; (2) Pre 40 mg/d + LEF 30 mg/d; and (3) Pre 25 mg/d + TAC 2 mg/d	SD	Cushing’s syndrome; Hypertension	Pre
7	49	M	+	44	(1) Pre 40 mg/d + CSA 150 mg/d; and (2) Pre 24 mg/d + TAC 2 mg/d	SD	Cushing’s syndrome; Steroid-induced diabetes	Pre + TAC
8	49	F	+	35	(1) Pre 50 mg/d + CTX 1000 mg iv; (2) Pre 30 mg/d + CSA 150 mg/d; and (3) TAC 3 mg/d	SR	Cushing’s syndrome; Liver damage; Steroid-induced diabetes	Non
9	36	F	+	18	(1) Pre 24 mg/d + CSA 100 mg/d; and (2) TAC 2 mg/d	SR	Non	Non

M: Male; F: Femle; PLA2R: Phospholipase A2 receptor; RTX: Rituximab; Pre: Prednisone; CAS: Cyclosporine; TAC: Tacrolimus; LEF: Leflunomide; SR: Steroid-resistant; SD: Steroid-dependent.

Table 2 Clinical outcomes

Patient No.	Before administering of RTX (0 mo)			After administering of RTX (6 mo)				Follow-up (12 mo)
	24 h UTP (g/d)	ALB (g/L)	Scr (μmol/L)	24 h UTP (g/d)	ALB (g/L)	Scr (μmol/L)	Remission	24 h UTP (g/d)	ALB (g/L)	Scr (μmol/L)	Remission
1	15.2	13.9	97	2.3	25.1	64	PR	1.88	44	66	PR
2	7.1	29	78	3.6	36.9	72	NR	2	36.2	83	PR
3	17	16	202	9.9	24.3	93	NR	4	29.9	116	PR
4	6.7	26	142	-	-	-	-	-	-	-	-
5	5.7	35	84	1.03	45.1	64	PR	0.09	49.5	90	CR
6	1.8	37.4	78	1.3	42	82	PR	0.6	40.1	75	PR
7	3.5	32.5	90	1.8	35.1	69	PR	0.27	44.1	88	CR
8	15	26.9	91	6.2	29.4	70	PR	0.9	41.4	82	PR
9	1.3	35.8	125	0.64	39.1	111	PR	0.175	42.2	124	CR

UTP: Urinary protein quantitation; RTX: Rituximab; ALB: Albumin; Scr: Serum creatinine; PR: Partial remission; CR: Complete remission; NR: No remission.

Table 3 Comparison of clinical outcomes during follow-up

Outcome	0 (mo)	3 (mo)	6 (mo)	9 (mo)	12 (mo)
24 h UTP (g/d)	8.14 ± 6.05	5.65 ± 4.99	3.35 ± 3.20	1.74 ± 1.81a	1.24 ± 1.34a
ALB (g/L)	28.06 ± 8.42	32.39 ± 8.7	34.63 ± 7.69	36.84 ± 6.74a	40.93 ± 5.85b,c
Scr (μmol/L)	109.67 ± 40.87	97.38 ± 27.34	78.13 ± 16.49a	84.5 ± 16.96	90.5 ± 19.81
Remission rate (%)	—	56% (5/9)	67% (6/9)	89% (8/9)	89% (8/9)

^aP < 0.05 vs 0 mo.

^bP < 0.01 vs 0 mo.

^cP < 0.05 vs 3 mo.

Data were analysed by one-way ANOVA followed by post hoc LSD test (albumin and serum creatinine) and presented as the mean ± SD. Data were analysed by Kruskal Wallis H test (24 h urinary protein quantitation).

UTP: Urinary protein quantitation; ALB: Albumin; Scr: Serum creatinine.

Table 4 Serum anti-phospholipase A2 receptor titer and CD 19⁺ B-cell count during administering of Rituximab

Patient No.	Before administering of RTX (0 mo)		Administering of RTX (3 mo)		After administering of RTX (6 mo)
	Anti-PLA2R titer (RU/mL)	CD19+ B (pcs/μL)	PLA2R antibody (RU/mL)	CD19+ B (pcs/μL)	PLA2R antibody (RU/mL)	CD19+ B (pcs/μL)
1	1400	418	104	0	Negative	0
2	180	6	96	0	82	0
3	215	169	67	0	48	0
4	500	422	-	-	-	-
5	32	114	27	0	20	0
6	45	28	Negative	0	Negative	0
7	52	460	22	0	17	0
8	130	192	38	0	Negative	0
9	36	258	21	0	Negative	0

RTX: Rituximab; PLA2R: Phospholipase A2 receptor.