Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
Int Immunopharmacol. 2022 Jun;107:108635. doi: 10.1016/j.intimp.2022.108635. Epub 2022 Feb 28.
The conventional treatment options (including alkylating agents, steroids, calcinurine inhibitors) have been largely replaced by anti-CD20 antibodies to achieve remission of nephrotic proteinuria in primary membranous nephropathy (PMN) patients. Two-third of rituximab-receiving PMN patients develop remission of proteinuria, and the results of MENTOR trial turned this drug into the first-line therapeutic agent in non-severe cases. However, in 20-40% of patients, remission is not achieved. Therefore, rituximab-resistant membranous nephropathy cases are increasingly reported. Different molecular mechanisms have been implicated in this context resulting in the introduction of new biologic agents. Second-generation anti-CD20 antibodies and other options such as plasma cell depleting agents and proteasome inhibition might lead to a novel treatment paradigm for patients with PMN.
传统的治疗方案（包括烷化剂、类固醇、钙调磷酸酶抑制剂）已在很大程度上被抗 CD20 抗体所取代，以实现原发性膜性肾病（PMN）患者肾病性蛋白尿的缓解。接受利妥昔单抗治疗的 PMN 患者中有三分之二会出现蛋白尿缓解，MENTOR 试验的结果使该药成为非重症病例的一线治疗药物。然而，仍有 20-40%的患者无法达到缓解。因此，利妥昔单抗耐药性膜性肾病病例越来越多。在这种情况下，不同的分子机制被认为与该疾病相关，导致了新型生物制剂的出现。第二代抗 CD20 抗体和其他选择，如浆细胞耗竭剂和蛋白酶体抑制，可能为 PMN 患者带来新的治疗模式。
