Obinutuzumab is effective for refractory primary membranous nephropathy

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PURPOSE: Primary membranous nephropathy has been recognized as an autoimmune disease since the discovery of anti-phospholipase A2 receptor (PLA2R) antibody. Anti-CD20 monoclonal antibodies are currently recommended as an effective therapeutic option. Among these, obinutuzumab (OBZ), a novel humanized type II anti-CD20 monoclonal antibody, has shown promise. However, studies evaluating the efficacy of OBZ in treating refractory membranous nephropathy remain limited. This study aims to evaluate the therapeutic outcomes of OBZ in patients with refractory membranous nephropathy. METHODS: We retrospectively analyzed 28 cases of refractory membranous nephropathy patients treated with OBZ at our center, with a minimum follow-up of 3 months. These patients had previously failed or relapsed after treatment with glucocorticoid plus cyclophosphamide, calcineurin inhibitors (CNIs), and/ or rituximab. The primary outcomes were complete remission (CR, proteinuria < 0.3 g/d) or partial mission (proteinuria < 3.5 g/d or with 50% reduction from baseline). RESULT: During a median follow-up of 13.2 months, 9 patients (32.1%) achieved CR, 16 patients (57.2%) achieved PR, resulting in an overall response rate of 89.3%. Three patients (10.7%) showed no response to OBZ treatment. Circulating CD19 B-cell count decreased < 5 cells/mL in 82.9% patients within 2 weeks post-infusion. Serum anti-PLA2R concentrations decreased to ≤ 2 RU/mL in 23 of 28 (82.1%) patients. Following OBZ administration, there was a significant reduction in 24-hour urine protein levels (median: 5.60 [IQR, 3.61-8.32] g/d at baseline vs. 0.51 [IQR, 0.16-1.33] g/d at the last visit, p < 0.05) and a significant increase in serum albumin levels (28.08 ± 7.03 g/L at baseline vs. 40.61 ± 5.89 g/L, p < 0.05). No serious adverse events were observed. CONCLUSION: This study demonstrates that OBZ was effective and well-tolerated in patients with refractory membranous nephropathy. These findings highlight its potential role in this population and warrant further validation in larger, multi-center studies.

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