首页|小剂量利妥昔单抗改善早期中高风险膜性肾病疾病进展:一项探索性研究

小剂量利妥昔单抗改善早期中高风险膜性肾病疾病进展:一项探索性研究

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  • 国家科技期刊平台
  • NETL
  • NSTL
  • 万方数据
膜性肾病(membranous nephropathy,MN)是成人原发性肾病综合征(nephrotic syndrome,NS)最常见的病因,近年来研究发现PLA2R是MN的关键致病靶抗原,且其发现给利妥昔单抗(rituximab,RTX)等靶向B细胞的治疗提供了理论基础,然而针对抗体的早期干预是否能有效地阻止MN的进展仍有待进一步探索.我们系统分析了 2019年10月至2023年3月在我中心接受RTX治疗的13例PLA2R抗体相关早期中高危MN患者的临床特征和随访.早期中高危MN定义为基线或入院时抗PLA2R抗体滴度超过50 RU/mL,但尚未出现NS状态.患者在基线评估中位时间4.1个月(IQR 1-7.7)启动RTX治疗,此后中位随访时间为27个月(IQR 23-45),期间均未发展至NS,12例(92.3％)在随访2年或末次随访时评估为完全或部分缓解.随访期间未发生死亡、严重感染或其他严重不良反应.RTX对早期中高危MN患者具有良好的疗效和安全性,适时启动抗体清除治疗可能有利于长期疾病控制和远期肾脏预后.
Low-dose rituximab improves progression in early-stage medium-to-high-risk membranous nephropathy:an exploratory study
Membranous nephropathy(MN)is the predominant cause of primary nephrotic syn-drome(NS)among adults.The identification of PLA2R as target antigen has brought about a pro-found transformation in the management of MN,offering a basis for the utilization of B-cell deplet-ing agents such as rituximab(RTX).The question of whether early intervention targeting antibodies can effectively impede the progression of MN,contrib-uting to enhanced disease control and long-term renal outcomes for patients,remains further explo-ration.We analyzed demographic data,laboratory parameters,and renal involvement in 13 patients with PLA2R antibody-related MN who received at least one RTX treatment at our center from Octo-ber 2019 to March 2023.Early-stage medium-to-high-risk MN was defined as baseline or admission anti-PLA2R antibody levels exceeding 50 RU/mL,ex-cluding patients who already presented with ne-phrotic syndrome at baseline.The median duration of MN at the initiation of the first RTX treatment was 4.1 months(IQR 1-7.7),and the median follow-up time after RTX therapy was 27 months(IQR 23-45).All patients had commenced renin-angiotensin system inhibitors before receiving RTX.Following RTX therapy,none of the 13 patients progressed to NS during the follow-up period,and 12 patients achieved complete or partial remission at the 2-year follow-up or the last visit.No deaths,severe infections,or other serious adverse reactions oc-curred during the follow-up period.In conclusion,RTX demonstrates favorable efficacy and safety in early-stage,medium-to-high-risk MN patients.Initi-ating antibody clearance therapy in these patients may be beneficial for long-term disease control and distant renal outcomes.

idiopathic membranous nephropa-thyadult nephrotic syndromeB cell depletion therapyanti-CD20 monoclonal antibodyanti-M-type phospholipase A2 receptor antibody

徐秋郁、艾三喜、王淦淦、贾淳钰、王佳慧、郑可、秦岩、陈罡、李雪梅

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中国医学科学院北京协和医学院北京协和医院肾内科,北京 100730

特发性膜性肾病 成人肾病综合征 B细胞耗竭疗法 抗CD20单抗 抗M型磷脂酶A2受体抗体

北京协和医院中央高水平医院临床科研专项默克-白求恩公益基金会项目

2022-PUMCH-B-020J202103E006

2024

10.12092/j.issn.1009-2501.2024.07.003

中国临床药理学与治疗学
中国药理学会

中国临床药理学与治疗学

CSTPCD北大核心
影响因子：0.97
ISSN：1009-2501
年,卷(期)：2024.29(7)