Frontiers in medicine · 2026
Efficacy and safety of different immunosuppressive agents in patients with calcineurin inhibitor-dependent primary membranous nephropathy.
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Li Zongying, Cao Shuyi, Liang Zheng, Zhao Fei, Li Kang
Аннотация
OBJECTIVE: To compare the efficacy and safety of rituximab (RTX), cyclophosphamide (CTX), and tripterygium glycosides (TII) as conversion therapies in patients with calcineurin inhibitor (CNI)-dependent primary membranous nephropathy (PMN), and to evaluate their ability to induce clinical and immunological remission and facilitate CNI withdrawal.
METHODS: Seventy-nine patients with CNI-dependent primary membranous nephropathy (PMN) admitted between January 2018 and June 2023 were retrospectively enrolled in this study, and divided into three groups: the RTX group (n = 37), the CTX group (n = 23), and the TII group (n = 19). The primary endpoints were the de novo complete remission rate and the complete CNI withdrawal rate at 12 months.
RESULTS: After 12 months of treatment, among patients who did not achieve complete remission at baseline, the rates of newly achieved complete remission and CNI withdrawal were significantly higher in the RTX and CTX groups than in the TII group (all p < 0.05). The immunological remission rate was significantly higher in the RTX group than in the TII group (p < 0.05). Urinary protein was significantly reduced and serum albumin was increased in all three groups, with stable renal function. The overall adverse event rate in the RTX group (8.11%) was significantly lower than that in the CTX group (30.43%) and the TII group (31.58%, all p < 0.05).
CONCLUSION: RTX and CTX are equally effective in treating CNI-dependent PMN, both significantly improving clinical complete remission rates and enabling successful CNI discontinuation. RTX shows advantages in achieving deeper immunological remission and better safety. TII can help reduce proteinuria and facilitate CNI tapering, making it suitable for patients intolerant to intensive immunosuppression or seeking a lower-risk treatment option.
METHODS: Seventy-nine patients with CNI-dependent primary membranous nephropathy (PMN) admitted between January 2018 and June 2023 were retrospectively enrolled in this study, and divided into three groups: the RTX group (n = 37), the CTX group (n = 23), and the TII group (n = 19). The primary endpoints were the de novo complete remission rate and the complete CNI withdrawal rate at 12 months.
RESULTS: After 12 months of treatment, among patients who did not achieve complete remission at baseline, the rates of newly achieved complete remission and CNI withdrawal were significantly higher in the RTX and CTX groups than in the TII group (all p < 0.05). The immunological remission rate was significantly higher in the RTX group than in the TII group (p < 0.05). Urinary protein was significantly reduced and serum albumin was increased in all three groups, with stable renal function. The overall adverse event rate in the RTX group (8.11%) was significantly lower than that in the CTX group (30.43%) and the TII group (31.58%, all p < 0.05).
CONCLUSION: RTX and CTX are equally effective in treating CNI-dependent PMN, both significantly improving clinical complete remission rates and enabling successful CNI discontinuation. RTX shows advantages in achieving deeper immunological remission and better safety. TII can help reduce proteinuria and facilitate CNI tapering, making it suitable for patients intolerant to intensive immunosuppression or seeking a lower-risk treatment option.