ORIGINAL RESEARCH article
Front. Med.
Sec. Nephrology
Combination of B-cell-guided Rituximab and Low-dose Tacrolimus for Primary Membranous Nephropathy: A Retrospective Cohort Study
Provisionally accepted
- 1Department of nephrology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
- 2Department of pharmacy, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
- 3Department of nephrology, Henan Provincial People's Hospital, Zhengzhou, China
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Background: This study compared the efficacy and safety of B-cell-guided RTX combined with low-dose tacrolimus (TAC) versus standard RTX monotherapy for the treatment of PMN. Methods: This retrospective analysis included 95 patients diagnosed with primary membranous nephropathy based on clinical evaluation and renal biopsy pathology. 57 received B-cell-guided RTX combined with low-dose TAC (observation group), while 38 received RTX monotherapy (standard group). In the observation group, RTX dosage was adjusted based on B-lymphocyte counts until B-cell depletion was achieved, accompanied by long-term oral low-dose TAC (0.02 mg/kg/day). Follow-up was conducted monthly after treatment to monitor peripheral blood lymphocyte subsets. RTX was re-administered if CD19+ B-lymphocytes rebounded to >5 cells/μL and the patient had not achieved complete remission. The standard group received two 1 g doses of administered two weeks apart. Over a six-month follow-up, remission rates, incidence of adverse events, and treatment costs were compared between the two regimens. Results: The overall remission rate in the observation group was 71.93%, with complete and partial remission rates of 31.58% and 40.35%, respectively. In the standard group, the overall remission rate was 68.42%, with complete and partial remission rates of 26.32% and 42.1%, respectively; none of these differences were statistically significant (P > 0.05). Logistic regression analysis identified age as an independent risk factor for failure to achieve complete remission (OR = 0.953, 95% CI: 0.920–0.987, P = 0.007). The observation group received a significantly lower total dose of RTX (0.3 ± 0.16g vs. 2g, t = 73.19, P = 0.000) and had reduced immunosuppressive therapy costs (5608.77 ± 2053.41 CNY vs. 26,000 CNY, t = 74.973, P = 0.000), resulting in average savings of approximately 20,391.23 CNY per patient. Non-serious adverse events totaled 12 in the observation group and 18 in the standard group. Overall safety was significantly higher in the observation group (χ² = 12.656, P = 0.001). Conclusion: B-cell-guided RTX combined with low-dose TAC effectively induces clinical remission in patients with primary membranous nephropathy, with a lower total RTX dose, improved safety profile, and better cost-effectiveness.
Keywords: B cell-guided, B-cell-targeted therapy, Primary membranous nephropathy, rituximab, Tacrolimus
Received: 05 Dec 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Wang, Huo, You, Dong, Gan, Zhang, Gu, Yan and Shao. 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: Fengmin Shao
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