Efficacy and safety of rituximab in the treatment of membranous nephropathy: A systematic review and meta-analysis

Medicine (Baltimore). 2020 Apr;99(16):e19804. doi: 10.1097/MD.0000000000019804.

Abstract

Background and objectives: Rituximab (RTX) is considered to be a promising drug for curing membranous nephropathy. However, the efficacy and safety of RTX in treating membranous nephropathy remain uncertain. This meta-analysis aimed to investigate the efficacy and safety of RTX in patients with membranous nephropathy.

Methods: A literature search was performed using Pubmed, Embase, OVID, and Cochrane Library and randomized controlled trials (RCTs) case-controls and cohort studies published till 30 July 2019 were assessed. The studies assessing the efficacy and safety of RTX in patients with membranous nephropathy were included.

Results: Eight relevant trials involving 542 patients were included in the meta-analysis. It was found that RTX did not significantly improve serum albumin levels and e-GFR when compared with the control group (including cyclosporine and cyclophosphamide, chlorambucil, prednisone, non-immunosuppressive anti-proteinuria treatment), serum albumin levels (OR = 0.31, 95%CI-0.12-0.74, P = .15), e-GFR (OR = -1.49, 95%CI-17.14-14.17, P = .85). However, RTX did reduce the serum creatinine (OR = -0.01, 95%CI-0.36-0.34, P = .95) and urinary protein (OR = -2.39, 95%CI -7.30 -2.53, P = .34) levels. Also, in comparison to the control group, RTX did improve the total remission rate (OR = 1.63, 95%CI 0.48-5.54, P = .43), achieve a higher rate of complete remission (OR = 2.54, 95%CI 1.65-3.90, P < .01) and also reduced the amount of M-type phospholipase A2 receptor-Antibody depletion in patients (OR = 5.59, 95%CI 1.81-17.2, P = .003). RTX-related adverse events were mostly mild (most infusion-related reactions) in nature and serious adverse events were rare.

Conclusion: RTX proved to be efficient, well-tolerated and a safe drug in the treatment of membranous nephropathy. Most patients reach complete remission during the follow-up period, and relapse is rare. RTX may turn out to be promising in membranous nephropathy patients.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents, Alkylating / therapeutic use
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Antineoplastic Agents, Immunological / adverse effects
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Case-Control Studies
  • Chlorambucil / therapeutic use
  • Cyclophosphamide / therapeutic use
  • Cyclosporine / therapeutic use
  • Female
  • Glomerular Filtration Rate / drug effects
  • Glomerulonephritis, Membranous / drug therapy*
  • Glomerulonephritis, Membranous / physiopathology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Prednisone / therapeutic use
  • Proteinuria / drug therapy
  • Randomized Controlled Trials as Topic
  • Receptors, Phospholipase A2 / drug effects
  • Receptors, Phospholipase A2 / immunology
  • Remission Induction
  • Rituximab / adverse effects
  • Rituximab / therapeutic use*
  • Safety
  • Serum Albumin / drug effects
  • Treatment Outcome

Substances

  • Antineoplastic Agents, Alkylating
  • Antineoplastic Agents, Hormonal
  • Antineoplastic Agents, Immunological
  • Immunosuppressive Agents
  • Receptors, Phospholipase A2
  • Serum Albumin
  • Chlorambucil
  • Rituximab
  • Cyclosporine
  • Cyclophosphamide
  • Prednisone