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Background <p>Primary membranous nephropathy (pMN) is characterized by a prolonged course, frequent relapses, and variable treatment responses. While obinutuzumab (OBI) demonstrates promising efficacy in B-cell depletion, its direct comparison with the combination regimen of rituximab (RTX) plus tacrolimus (TAC) remains limited. This study aimed to evaluate the efficacy and safety of OBI monotherapy versus RTX + TAC in patients with refractory pMN.</p> Methods <p>We retrospectively enrolled 28 patients with biopsy-proven pMN from a single center, assigned to RTX + TAC (<i>n</i> = 13) or OBI (<i>n</i> = 15) groups according to treatment regimen. Clinical remission, immunological remission (IR), and adverse events were assessed over 24 months of follow-up.</p> Results <p>No significant differences were observed in serum creatinine, estimated glomerular filtration rate (eGFR), serum albumin, urine protein excretion, or anti-phospholipase A2 receptor (PLA2R) antibody titers between the two study groups. In contrast, disease duration differed substantially between groups: the OBI group exhibited a significantly longer median disease duration (87.7 (29, 168) months) compared with the RTX + TAC group (14 (7, 36) months). At the end of follow-up, the cumulative clinical remission rate (achieving complete remission or partial remission) was 89.1% among 11 patients included in the RTX + TAC group, and 92.9% among 14 patients in the OBI group. For IR, the cumulative IR rate was 60.0% among 10 patients in the RTX + TAC group and 90.9% among 11 patients in the OBI group. Kaplan–Meier survival analysis further demonstrated a statistically significant difference in cumulative IR rates between the two groups (<i>P</i> = 0.03).</p> Conclusion <p>OBI monotherapy achieved comparable 24-month clinical remission and safety to RTX + TAC in pMN, but with superior IR rates. These findings support B-cell depletion as a central therapeutic strategy, though long-term clinical benefits require further study.</p>

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Comparison of the efficacy of obinutuzumab versus rituximab combined with tacrolimus in the treatment of refractory membranous nephropathy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月9日

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  • Yulong Zhang,
  • Mengnan Guo,
  • Qi Bian,
  • Shuangxi Li,
  • Jing Sun,
  • Zhenyu Qin,
  • Jing Xu,
  • Rui Dong

摘要

Background

Primary membranous nephropathy (pMN) is characterized by a prolonged course, frequent relapses, and variable treatment responses. While obinutuzumab (OBI) demonstrates promising efficacy in B-cell depletion, its direct comparison with the combination regimen of rituximab (RTX) plus tacrolimus (TAC) remains limited. This study aimed to evaluate the efficacy and safety of OBI monotherapy versus RTX + TAC in patients with refractory pMN.

Methods

We retrospectively enrolled 28 patients with biopsy-proven pMN from a single center, assigned to RTX + TAC (n = 13) or OBI (n = 15) groups according to treatment regimen. Clinical remission, immunological remission (IR), and adverse events were assessed over 24 months of follow-up.

Results

No significant differences were observed in serum creatinine, estimated glomerular filtration rate (eGFR), serum albumin, urine protein excretion, or anti-phospholipase A2 receptor (PLA2R) antibody titers between the two study groups. In contrast, disease duration differed substantially between groups: the OBI group exhibited a significantly longer median disease duration (87.7 (29, 168) months) compared with the RTX + TAC group (14 (7, 36) months). At the end of follow-up, the cumulative clinical remission rate (achieving complete remission or partial remission) was 89.1% among 11 patients included in the RTX + TAC group, and 92.9% among 14 patients in the OBI group. For IR, the cumulative IR rate was 60.0% among 10 patients in the RTX + TAC group and 90.9% among 11 patients in the OBI group. Kaplan–Meier survival analysis further demonstrated a statistically significant difference in cumulative IR rates between the two groups (P = 0.03).

Conclusion

OBI monotherapy achieved comparable 24-month clinical remission and safety to RTX + TAC in pMN, but with superior IR rates. These findings support B-cell depletion as a central therapeutic strategy, though long-term clinical benefits require further study.