Терапия ритуксимабом не показала преимуществ перед другими методами лечения у пациентов с чистым волчаночным мембранозным нефритом

Although rituximab-based therapy achieved numerically higher remission rates while reducing corticosteroid exposure and treatment duration, 12-month renal response rates did not differ significantly among immunosuppressive strategies in patients with pure lupus membranous nephropathy (PLMN), , according to findings from a multicenter French study published in Kidney International. The retrospective cohort included 194 patients with biopsy-proven first-onset PLMN treated at 25 French centers from 2000 to 2020. Most patients were female (n=87.6%), the median age at systemic lupus erythematosus diagnosis was 28 years, and 44.3% of patients were of Afro-Caribbean origin. At PLMN diagnosis, median estimated glomerular filtration rate was 122.1 (98.7–133.6) mL/min/1.73 m², serum albumin was 28.6 (21–33) g/L, and urine protein-to-creatinine ratio was 2.2 (1.2–4.5) g/g; 67 of 180 patients (37.2%) had nephrotic syndrome. Fifty-three patients (27.3%) received supportive care alone, and141 (72.7%) received immunosuppression therapy. Among the latter group, 54 (38.3%) received mycophenolate mofetil-based regimens, 26 (18.4%) received rituximab-based regimens, and 61 (43.2%) received other therapies. At 12 months, 36.7% of patients assigned to supportive care experienced complete renal response (CRR) compared with 47.1% assigned to mycophenolate mofetil, 64.0% treated with rituximab, and 45.4% who received other regimens. Combined CRR or partial renal response occurred in 55.1%, 60.8%, 72.0%, and 54.5%, respectively. Eighteen of 49 patients (36.7%) receiving supportive care and 65 of 131 (49.6%) receiving immunosuppression had CRR at 12 months (P =.12). Overall renal response was likewise comparable between supportive care and immunosuppression (55.1% vs 60.3%; P =.53). Rituximab was associated with the shortest treatment duration (P <.01) and lower corticosteroid exposure, although adjusted comparisons did not show statistically significant superiority for renal response. Adjusted odds ratios for rituximab compared to other immunosuppressive approaches ranged from 2.13 to 2.33 for CRR and 1.77 to 2.25 for overall response, but confidence intervals were wide and P-values ranged from .11 to .32. Proteinuria declined significantly from treatment initiation through months 6 and 12 across all groups (P <.001) without significant differences in trajectories between treatment strategies (P =.45). Serum albumin increased over time (P <.001), with no between-group difference (P =.62). Investigators also concluded that anti-U1-ribonucleoprotein (U1RNP) antibodies and the absence of extrarenal lupus manifestations identify patients at greater risk for treatment failure. Baseline proteinuria was not associated with treatment failure. Anti-U1RNP positivity independently predicted treatment failure (adjusted OR, 2.53; 95% CI, 1.35–4.70; P =.004). Extrarenal lupus involvement, however, was associated with a lower risk of treatment failure (adjusted OR, 0.39; 95% CI, 0.19–0.73; P =.004). “Despite similar trajectories of proteinuria and serum albumin, and comparable rates of renal and extrarenal flare during follow-up across groups,” the authors wrote, “rituximab was associated with reduced corticosteroid exposure without compromising remission rates, supporting its prospective evaluation, along with other B-cell–targeting therapies.” “Treatment failure was not associated with baseline proteinuria levels or steroid dose, but rather with the presence of anti-U1RNP antibodies and the absence of extrarenal manifestations, challenging proteinuria-centered treatment paradigms and underscoring the need for more individualized strategies in PLMN management,” Chevalier and colleagues concluded. Disclosures: No funding was listed for this study. One or more authors reported conflicts. Please see the original reference for full disclosures. References: Chevalier K, Brousse R, Karras A, et al. Outcomes and predictors of treatment response in patients with pure lupus membranous nephropathy. Kidney Int Rep. Published online July 8, 2026. doi:10.1016/j.ekir.2026.106678