The Journal of Practical Medicine >

2025 , Vol. 41 >Issue 17: 2740 - 2747

DOI: https://doi.org/10.3969/j.issn.1006-5725.2025.17.019

Drugs and Clinic Practice

Comparison of clinical efficacy of different doses of rituximab combined with tacrolimus in the treatment of idiopathic membranous nephropathy

  • Ruihua SHANG ,
  • Qian LI ,
  • Minghao GUO ,
  • Xiangdong LIU ,
  • Shulong WANG ,
  • Huilin XING ,
  • Jin LI
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  • 1.The Second Ward of Nephrology Hospital，the First Affiliated Hospital of Xinxiang Medical University，Xinxiang 453100，Henan，China
    2.Xinxiang Key Laboratory of Microfluidic Immunodiagnosis for Kidney Diseases，Xinxiang 453100，Henan，China

Received date: 2025-05-23

  Online published: 2025-09-05

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Abstract

Objective To investigate the effect of two treatment regimens combining Tacrolimus （TAC） with different Rituximab （RTX） dosages， and to provide clinical reference for treatment strategies. Methods A retrospective analysis was conducted on patients diagnosed with idiopathic membranous nephropathy （IMN） and treated with RTX combined with TAC regimen （RTX + TAC group and low?dose RTX + TAC group） in The First Affiliated Hospital of Xinxiang Medical University. Propensity score matching （PSM） was performed at a 1∶1 ratio， and a total of 60 patients were enrolled， with 30 in each group. In low?dose RTX （375 mg/m2 at the first and fifteenth day respectively） + TAC group， if circulating B cells （CD19?） exceeded 5 cells/μL after 3 months， a 200 mg RTX infusion was administered. In RTX （1g at the first and fifteenth day respectively） + TAC group， if complete remission （CR） was not achieved by 6 months， an additional 1000 mg RTX infusion was administered. The incidence of CR， partial remission， and adverse events were followed up for 12 months after medication in both groups. Results （1） Both groups showed significant reductions in 24?hour proteinuria， with the RTX + TAC group demonstrating a notably higher decrease compared to the low?dose RTX + TAC group. Statistical differences were observed between the two groups at the 1st and 3rd months of treatment （P < 0.05）. Albumin levels gradually increased， and there were differences between the two groups at both the 1st and 3rd months （P < 0.05）. The anti?phospholipase A2 antibody levels decreased significantly after one month of treatment ［3.45（1.90， 22.10） vs. 3.28（8.30， 23.08） RU/mL］， P > 0.05. At 3 months of treatment， the overall clinical remission rate was 63.3% for the RTX + TAC group compared to 36.7% for the low?dose RTX + TAC group （P < 0.05）. At 12 months， the RTX + TAC group achieved an overall remission rate of 86.7%， while the low?dose RTX + TAC group reached 83.3%， showing no statistical significance （P > 0.05）. After one month of treatment， the RTX + TAC group achieved a complete serological immunological remission rate of 33.3%， significantly higher than the 3.3% in the low?dose RTX + TAC group （P < 0.05）. （2） The cumulative remission rate of the RTX + TAC group was higher than that of the low?dose RTX + TAC group during the first 6 months of follow?up. The remission rate in the low?dose RTX+TAC group increased significantly after 6 months. Log?rank test showed no statistical difference between the survival curves of the two groups （P = 0.37）. （3） Based on a multifactorial COX regression analysis of factors related to remission in patients with IMN， for every unit increase in serum immunological remission time， the risk of patients achieving remission decreased by 13.5% （HR = 0.87，P = 0.016）. The risk of remission for patients with high titers of anti?PLA2R antibodies decreased by 60.2% （HR = 0.39，P = 0.018）. Conclusions Different RTX dosages yielded comparable overall clinical remission rates without significantly increasing adverse events. RTX + TAC regimen achieves higher early CR rate. Serological remission time and high titer anti?PLA2R antibodies are associated with clinical outcomes.

Key words： idiopathic membranous nephropathy; rituximab; tacrolimus

Cite this article

Ruihua SHANG , Qian LI , Minghao GUO , Xiangdong LIU , Shulong WANG , Huilin XING , Jin LI . Comparison of clinical efficacy of different doses of rituximab combined with tacrolimus in the treatment of idiopathic membranous nephropathy[J]. The Journal of Practical Medicine, 2025 , 41(17) : 2740 -2747 . DOI: 10.3969/j.issn.1006-5725.2025.17.019

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