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Combination of rituximab, low-dose cyclophosphamide, and prednisone for primary membranous nephropathy: A case series with extended follow up

American Journal of Kidney Diseases Jun 27, 2021

Zonozi R, Laliberte K, Huizenga NR, et al. - This single-center retrospective case series was conducted to assess longer-term remission and relapse rates, anti-phospholipase A2 receptor antibody levels, B cell levels, as well as serious adverse events among patients suffering from primary membranous nephropathy (PMN) who underwent treatment with rituximab combined with an initial short course of low-dose oral cyclophosphamide and a course of rapidly tapered prednisone (RCP). This study involved 60 consecutive patients with PMN managed with RCP. Post-treatment start, a median follow-up of 38 months was conducted; 100% of cases achieved partial remission, described as a urinary protein to creatinine ratio (UPCR) < 3 g/g and a 50% decrease from baseline, at a median of 3.4 months. Complete remission, defined as a UPCR < 0.3 g/g, was achieved by 83%, by 2 years following treatment commencement. At 2 years post- B cell reconstitution, 10% of patients suffered relapse. Occurrence of 18 SAEs was revealed over a combined follow-up time of 228 patient-years. Findings showed RCP had an acceptable safety profile and conferred partial remission in all and a durable complete remission in most patients with PMN.

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