title: Low-dose rituximab is poorly effective in patients with primary membranous nephropathy.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nephrological Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Milano, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Moroni
authors.affiliation: Nephrological Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Milano, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Depetri
authors.affiliation: Department of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Del Vecchio
authors.affiliation: Nephrology, S. Anna Hospital, Como, Italy.
authors.forename: Beniamina
authors.initials: B
authors.lastname: Gallelli
authors.affiliation: Nephrological Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Milano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Raffiotta
authors.affiliation: Nephrological Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Milano, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Giglio
authors.affiliation: Clinical Immunology Unit & Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Brunini
authors.affiliation: Nephrology, S. Anna Hospital, Como, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: D'Amico
authors.affiliation: Department of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Selena
authors.initials: S
authors.lastname: Longhi
authors.affiliation: Microbiology and Virology Department, S. Carlo Borromeo Hospital, Milano, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Radice
authors.affiliation: Nephrological Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico Milano, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
authors.affiliation: Department of Medicine and Surgery, Università degli Studi di Milano, Monza (MB), Italy.
authors.forename: Renato Alberto
authors.initials: RA
authors.lastname: Sinico
mesh_terms: D000328:Adult; D000368:Aged; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D054507:Receptors, Phospholipase A2 / Q000097:blood; D012074:Remission Induction; D000069283:Rituximab / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000074322:Antineoplastic Agents, Immunological; D015415:Biomarkers; C516360:PLA2R1 protein, human; D054507:Receptors, Phospholipase A2; D000069283:Rituximab
keywords: membranous nephropathy; nephrotic syndrome; rituximab