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Review
. 2025 Feb 8;18(3):sfaf039.
doi: 10.1093/ckj/sfaf039. eCollection 2025 Mar.

The role of obinutuzumab in rituximab-refractory membranous nephropathy and minimal change disease

Zewei Chen  1   2 , Dechao Xu  1 , Shuangcheng Wu  1 , Wenyu Liu  1 , Jianxiang Wu  3 , Shengqiang Yu  1 , Bing Dai  1 , Zhiguo Mao  1 , Xiang Gao  1
Affiliations
Review

The role of obinutuzumab in rituximab-refractory membranous nephropathy and minimal change disease

Zewei Chen et al. Clin Kidney J. .

Abstract

Background: Obinutuzumab, a new-generation anti-CD20 monoclonal antibody, was originally developed to overcome resistance to rituximab in B-cell malignancies. There is limited research regarding the use of obinutuzumab in patients with rituximab-refractory membranous nephropathy (MN) and minimal change disease (MCD).

Methods: A retrospective analysis was performed at Changzheng Hospital from September 2022 to September 2024, and screened patients with rituximab-refractory MN or MCD. Participants were treated because they were refractory to rituximab and consented to receive infusions of obinutuzumab. Primary outcomes were defined as complete remission (CR, proteinuria <0.3 g/d) or partial remission (PR, proteinuria <3.5 g/d with a ≥50% reduction). Secondary outcome was immunological remission in patients with phospholipase A2 receptor (PLA2R)-related MN.

Results: Seven patients with MN and five with MCD were included in the cohort. Among patients with MN, six of seven (86%) achieved at least PR, of whom two patients reached CR with a median time to first remission (either PR or CR) of 8.0 months. Among patients with positive serum anti-PLA2R antibodies at baseline, all achieved an immunological response. No patients experienced a relapse during the follow-up period. Among patients with MCD, all patients achieved a CR with the median time of 1.0 months. Patients who were steroid-dependent or immunosuppressant-dependent were able to taper their medications in the short term without experiencing relapse. No treatment-related severe adverse events were reported.

Conclusions: Our study demonstrated that obinutuzumab represents a promising alternative therapeutic option for the management of rituximab-refractory MN and MCD.

Keywords: membranous nephropathy; minimal change disease; nephrotic syndrome; obinutuzumab; rituximab.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Probability of achieving remission (either partial or complete) after obinutuzumab infusion.
See this image and copyright information in PMC

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