Low-dose rituximab is poorly effective in patients with primary membranous nephropathy

Nephrol Dial Transplant. 2017 Oct 1;32(10):1691-1696. doi: 10.1093/ndt/gfw251.


Background: The optimal dosing and the efficacy of rituximab for primary membranous nephropathy (PMN) has not been established. This multicentric prospective study evaluates the efficacy and safety of low-dose rituximab (RTX) therapy in patients with PMN in clinical practice.

Methods: Thirty-four consecutive patients with PMN and nephrotic syndrome were included and received RTX (375 mg/m2) once (18 patients) or twice (16 patients). RTX was the first-line therapy for 19 (56%) and the second line for 15 (44%) patients. All patients were followed for 12 months after RTX and 24 for at least 18 months (mean 23.9 ± 18.6 months).

Results: At 12 months, 5 patients (14.7%) achieved complete response, 10 (29.4%) partial and 19 (55.8%) no response. Response occurred ∼6 months after RTX. At 24 months, the clinical situation was unchanged: two non-responders achieved partial response and two responders relapsed. Responders had significantly higher baseline GFR and lower anti-PLA2R antibodies compared with non-responders. Outcome was similar between one or two doses of RTX (non-responders 55.5 versus 56%, respectively) and between patients who had received previous therapy versus those receiving RTX as first-line therapy (non-responders 40 versus 68%, respectively). In the 15 patients already treated, the response to RTX was comparable to that of previous therapies.

Conclusion: Low-dose RTX obtains remission in <50% of PMN patients. Probably, higher doses and longer treatments are needed to induce and maintain a response. The balance between the costs and benefits should guide the selection of the patient and the optimal dosage.

Keywords: membranous nephropathy; nephrotic syndrome; rituximab.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Biomarkers / blood
  • Female
  • Glomerulonephritis, Membranous / blood
  • Glomerulonephritis, Membranous / drug therapy*
  • Glomerulonephritis, Membranous / pathology
  • Humans
  • Male
  • Middle Aged
  • Nephrotic Syndrome / blood
  • Nephrotic Syndrome / drug therapy*
  • Nephrotic Syndrome / pathology
  • Prospective Studies
  • Receptors, Phospholipase A2 / blood
  • Remission Induction
  • Rituximab / therapeutic use*
  • Treatment Outcome
  • Young Adult


  • Antineoplastic Agents, Immunological
  • Biomarkers
  • PLA2R1 protein, human
  • Receptors, Phospholipase A2
  • Rituximab