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. 2025 Apr 29:5:1548679.
doi: 10.3389/fneph.2025.1548679. eCollection 2025.

Efficacy and safety of rituximab for membranous nephropathy in adults: a meta-analysis of RCT

Baike Mao  1 , Jiahui Han  1 , Jia Wang  2 , Kan Ye  2
Affiliations

Efficacy and safety of rituximab for membranous nephropathy in adults: a meta-analysis of RCT

Baike Mao et al. Front Nephrol. .

Abstract

Background: Membranous nephropathy (MGN) represents a significant challenge in nephrology, with Rituximab emerging as a potential therapeutic intervention.

Methods: A comprehensive systematic review was conducted using PubMed, EMBASE, and Web of Science databases, focusing exclusively on randomized controlled trials (RCTs) from January 2002 to November 2024. Stringent eligibility criteria were applied, including studies with at least ten participants, with data extracted by two independent reviewers. The meta-analysis utilized fixed and random effects models to assess Rituximab's efficacy and safety across multiple outcome measures.

Results: The meta-analysis revealed nuanced findings across different follow-up periods. At 6 months, complete remission rates showed non-significant odds ratios ranging from 2.12 to 2.48. By 12 months, the pooled odds ratio was 0.8085 (95% CI: 0.2238-2.9213), with complete remission rates varying between 13.8% and 19.4%. Notably, at 24 months, the common effects model demonstrated a statistically significant odds ratio of 5.0792 (95% CI: 2.2609-11.4107, p < 0.0001). Proteinuria reduction showed consistent improvement, with a median difference of 4.3225. Adverse event analysis indicated a relatively low risk, with an odds ratio of 0.9706 (95% CI: 0.5781-1.6297).

Conclusion: Rituximab demonstrates potential efficacy in treating MGN, with promising long-term outcomes and a favorable adverse event profile.

Keywords: RCT; membranous nephropathy; meta-analysis; proteinuria; rituximab.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection process.
Figure 2
Figure 2
Summary for risk of bias assessment across included studies.
Figure 3
Figure 3
Forest plot of evaluation of complete remission rates for Rituximab in MGN. (A) Forest plot of evaluation of 6-month complete remission rates. (B) Forest plot of evaluation of 12-month complete remission rates. (C) Forest plot of evaluation of 24-month complete remission rates. The forest plot shows the odds ratios for each study along with their 95% confidence intervals. The horizontal lines represent the 95% confidence intervals for each study. The squares represent the point estimates of the odds ratios, with the size of the square indicating the weight of the study. The diamond at the bottom represents the summary estimate of the odds ratio for the meta-analysis. The common effect model and the random effects model both show a positive trend towards rituximab, but neither model found a statistically significant result (p-value > 0.05).
Figure 4
Figure 4
Forest plot of the 12-month complete remission rates for rituximab combination therapies in MGN.
Figure 5
Figure 5
Forest plot of evaluation of composite remission rates for rituximab in MGN. (A) Forest plot of evaluation of 6-month composite remission rates. (B) Forest plot of evaluation of 12-month composite remission rates. (C) Forest plot of evaluation of 24-month composite remission rates.
Figure 6
Figure 6
Forest plot of the 12-month composite remission rates for rituximab combination therapies in MGN.
Figure 7
Figure 7
Proteinuria reduction and adverse event risks in rituximab therapy. (A) Forest plot of proteinuria reduction. (B) Forest plot of proteinuria reduction across follow-up subgroups. (C) Forest plot of adverse event risks in rituximab studies.
See this image and copyright information in PMC

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