# Comparison of the efficacy of low, moderate and standard doses of rituximab in the treatment of membranous nephropathy

## TL;DR

This study compared low, moderate, and standard doses of rituximab for treating membranous nephropathy and found similar effectiveness across all doses.

## Contribution

The study provides new evidence that different rituximab dosing regimens have comparable efficacy in treating membranous nephropathy.

## Key findings

- All three doses of rituximab significantly reduced anti-PLA2R antibody levels and urinary protein.
- Serum albumin levels increased significantly in all groups, with no significant impact on renal function.
- No significant differences in remission rates or adverse reactions were observed between the three dosing regimens.

## Abstract

Rituximab (RTX) is recommended as a first-line therapy for membranous nephropathy (MN); however, the efficacy of different dosing regimens remains controversial. This study aimed to evaluate and compare the efficacy of low-dose, moderate- and standard-dose RTX in treating MN.

One hundred patients with MN who received RTX at the Affiliated Hospital of Xuzhou Medical University and Huaihai Hospital of Xuzhou Medical University between May 2021 and December 2024 were included. The patients were divided into three groups: a low-dose group (n = 31; 100 mg per dose), a moderate-dose group (n = 32; 500 mg per dose) and a standard-dose group (n = 37; 375 mg/m2 per dose). The remission rates and clinical indicators, including 24-h urinary total protein (24-UTP), serum albumin, and M-type phospholipase A2 receptor (PLA2R) levels, were compared between the three groups.

After 12 months of treatment, for 24 h-UTP, CD20+ B lymphocyte count, and anti-PLA2R-Ab: among the three groups showed significant reductions compared to baseline (p < 0.05). Serum albumin: among the three groups had significant increases versus baseline (p < 0.05); no significant changes were observed in serum creatinine or glomerular filtration rate compared to baseline (p > 0.05). For disease remission: the overall response rate was 67.74% in the low-dose group (n = 31), 65.63% in the moderate-dose group (n = 32) and 64.84% in the standard-dose group (n = 37). After 12 months, with no statistically significant difference among the three groups (p > 0.05). For adverse reactions: there was no significant difference in the incidence of adverse reactions among the three groups (p > 0.05).

Three treatment regimens significantly reduced anti-PLA2R antibody titers and urinary protein levels, while increasing serum albumin, without a significant impact on renal function. The therapeutic efficacy of the three doses was comparable.