Lu Luying, Cai Shasha, Zhu Huayan, Liu Guangjun, Wang Yaomin, Ren Pingping, Lan Lan, Shen Xiaoqi, Chen Liangliang, Xu Ying, Cheng Jun, Li Xiayu, Chen Jianghua, Han Fei
Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Nephrology, The First People's Hospital of Wenling, Taizhou, China.
BMC Nephrol. 2024 Dec 24;25(1):473. doi: 10.1186/s12882-024-03912-4.
To compare the efficacy and safety of rituximab (RTX), calcineurin inhibitor (CNI) and cyclophosphamide (CTX) plus glucocorticoids in the treatment of primary membranous nephropathy (PMN).
Totally 478 biopsy-proven PMN patients in single center were retrospectively included. After 1:1 propensity score matching (PSM), 258 patients were included in RTX, CNI or CTX group (86 patients in each group).
After PSM, there were no differences on serum creatinine, eGFR, serum albumin, urine protein, anti-PLA2R antibody levels among groups. The follow-up duration was 12 (10.5, 18) months in CNI group, 12 (12, 18) months in CTX group and 12 (12, 18) months in RTX group. Throughout entire follow-up period, 39 patients (45.3%) in CNI group, 47 patients (54.7%) in CTX group, and 59 patients (68.6%) in RTX group achieved total remission (TR, either complete remission or partial remission). The survival curve showed a higher rate of TR in RTX group than CNI group (p = 0.018). A relapse occurred in 15 of 39 (38.5%) patients in CNI group, significantly higher than CTX group (4.3%, p < 0.001) and RTX group (3.4%, p < 0.001). In CNI group, 36% patients had a ≥ 25% decline in eGFR.
RTX may be more effective than CNI in inducing remission in PMN and showed similar efficacy to CTX. CNI may have a high risk of proteinuria relapse and eGFR decline.
比较利妥昔单抗（RTX）、钙调神经磷酸酶抑制剂（CNI）以及环磷酰胺（CTX）联合糖皮质激素治疗原发性膜性肾病（PMN）的疗效和安全性。
回顾性纳入单中心478例经活检证实的PMN患者。经1:1倾向评分匹配（PSM）后，将258例患者分为RTX组、CNI组或CTX组（每组86例）。
PSM后，各组间血清肌酐、估算肾小球滤过率（eGFR）、血清白蛋白、尿蛋白、抗磷脂酶A2受体（anti-PLA2R）抗体水平无差异。CNI组随访时间为12（10.5，18）个月，CTX组为12（12，18）个月，RTX组为12（12，18）个月。在整个随访期间，CNI组39例患者（45.3%）、CTX组47例患者（54.7%）以及RTX组59例患者（68.6%）达到完全缓解（TR，包括完全缓解或部分缓解）。生存曲线显示RTX组的TR率高于CNI组（p = 0.018）。CNI组39例患者中有15例（38.5%）复发，显著高于CTX组（4.3%，p < 0.001）和RTX组（3.4%，p < 0.001）。在CNI组中，36%的患者eGFR下降≥25%。
RTX在诱导PMN缓解方面可能比CNI更有效，且与CTX疗效相似。CNI可能有蛋白尿复发和eGFR下降的高风险。
