ORIGINAL RESEARCH article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1650054
This article is part of the Research TopicEmerging Therapies in Glomerulonephritis: Focus on Complement Regulators and Novel TargetsView all articles
Efficacy and Safety of Obinutuzumab in Primary Membranous Nephropathy: A Real-World Retrospective Study
Provisionally accepted
Xi Cheng
Zhen-Feng ZhengYan QiXin CaoXi-Qian GaoYing-Xin FangWei LiWen-Ya ShangTie-Kun YanJun-Ya Jia
Pengcheng XuQiu-Hua Gu*- Tianjin Medical University General Hospital, Tianjin, China
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Objective: This study aimed to evaluate the efficacy and safety of obinutuzumab, a novel anti-CD20 monoclonal antibody, in patients with primary membranous nephropathy (pMN).Methods: Fifty-five patients with pMN treated with obinutuzumab were respectively enrolled in this study. Clinical and immunological response, renal function and adverse events were assessed throughout the follow-up period between patients receiving obinutuzumab as initial therapy and alternative therapy.The study included 40 patients receiving obinutuzumab as an alternative therapy, and 15 patients receiving it as an initial therapy. During a follow up of 13.0(10.0, 18.0) months after obinutuzumab treatment, 23/25(92.0%) patients achieved immunological remission. 46/55(83.6%) patients achieved clinical remission (including 40.0% of PR and 43.6% of CR), with significantly reduced proteinuria and increased serum albumin. Patients with obinutuzumab as either the initial or alternative treatment showed similar clinical response (85.0 vs. 80.0%, P=0.692). 13 out of 18 patients (72.2%) with impaired kidney function (eGFR <60 mL/min/1.73 m²) also showed significant response to obinutuzumab, along with eGFR increasing from 35.3 to 47.6 mL/min/1.73m². Furthermore, obinutuzumab also had a comparable efficiency in patients without response to previous rituximab treatment and patients with negative anti-PLA2R antibody. More patients in the initial therapy group had infusion-related reactions (33.3 vs. 15.0%, P=0.149), while severe infections were all occurred in the alternative therapy group, particularly those with a history of long-term immunosuppressive therapy.Conclusions: Obinutuzumab, used as both initial and alternative therapy, can induce significant clinical response in patients with pMN, implying its potentially promising therapeutic effect on pMN.
Keywords: Membranous nephropathy, Obinutuzumab, rituximab, Anti-phospholipase A2 receptor antibody, Renal function
Received: 19 Jun 2025; Accepted: 04 Aug 2025.
Copyright: © 2025 Cheng, Zheng, Qi, Cao, Gao, Fang, Li, Shang, Yan, Jia, Xu and Gu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qiu-Hua Gu, Tianjin Medical University General Hospital, Tianjin, China
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