Rituximab is associated with accelerated dialysis independence in anti-glomerular basement membrane disease: a retrospective cohort analysis of renal survival.

OBJECTIVE

This study aimed to evaluate the efficacy of rituximab (RTX) in the treatment of anti-glomerular basement membrane disease (anti-GBM disease) and to analyze the clinicopathological factors associated with long-term renal outcomes.

METHODS

This study enrolled a total of 66 patients with confirmed anti-GBM disease. Patients were divided into two groups: the control group (n=52) received conventional therapy, including plasma exchange, glucocorticoids, and cyclophosphamide as clinically indicated, and the RTX group (n=14) received RTX in addition to the same conventional therapy. The baseline characteristics, treatment responses, and long-term outcomes were compared between the two groups.

RESULTS

The baseline clinical and pathological characteristics were balanced and comparable between the two groups. Although the RTX group demonstrated only numerical advantages in the absolute rate of dialysis independence (50.0% vs. 21.05%, p=0.107) and the 3-year ESRD incidence (42.86% vs. 63.46%, p=0.223), the median time to dialysis independence was significantly shorter in the RTX group compared to the control group (26 vs. 41 days, p=0.009). Kaplan-Meier survival analysis indicated a trend towards higher renal survival in the RTX group, but the difference was not statistically significant (HR = 0.640, p=0.169). Prognostic factor analysis indicated that worse baseline renal function, anemia, hypoalbuminemia, elevated BNP, initial dialysis dependency, and absence of cyclophosphamide treatment were associated with progression to ESRD at 3 years.

CONCLUSION

In patients with anti-GBM disease, the addition of RTX to standard therapy was associated with accelerated recovery of renal function, as evidenced by a shorter time to dialysis discontinuation. These findings suggest a potential renal recovery benefit of RTX, warranting further validation in larger, prospective studies.