Calcineurin inhibitor combined with Rituximab is superior to combined with glucocorticoids or RTX alone in the treatment of IMN：A retrospective study

• DOI: 10.20944/preprints202402.0719.v1
• Publication Date: 2024-02-14T09:52:28Z
• Authors: Xiang long Sun; Jian ying Wang; Kai li Fan; Fang Yin; Li li Qin; Li jie Su; Jing shu Sun; Yue Xu; Kun ying Zhang

BACKGROUND Studies demonstrate that T cells secrete interleukin and other cytokines to promote the growth activation of B cells, lymphocytes release antibodies attach PLA2R THSD7A surface antigens on podocytes create immunological complexes are deposited beneath glomerular epithelium, which damage filtration barrier trigger proteinuria.The combination regimen Calcineurin inhibitors（CNIs）and rituximab(RTX) could simultaneously inhibit proliferation reduced production immune complexes.This kind therapeutic method for idiopathic membranous nephropathy may achieve better clinical results less complications. METHODS Fifty-eight patients who were diagnosed as nephropathy（IMN）through a biopsy suffering from nephrotic syndrome (NS) recruited, divided into RTX treatment group(RTX group), CNIs combined with group(CNIs+RTX group) glucocorticoids(GC) group(CNIs+CG according their background. All in 3 groups followed up at least 12 months. Clinical composite remission(including complete or partial remission) months was main result; safety incidence adverse events secondary outcomes. RESULTS The antibody level RTX+CNIs group baseline much higher than CNIs+GC (240.30(84.56,386.99)RU/ml vs. 44.94(11.48,143.94)RU/ml, 7.72(2.00,102.68) RU/ml, respectively, p=0.006). concentrations among three become comparable end months(36.80(2.10,88.05) RU/ml vs.14.32(2.00,47.98)RU/ml, 2.60(2.00,24.50) p>0.05). At months, all achieved remission, PLA2R-ab concentration 14RU/ml. 33of 58 patients(56.90%) had remission(complete remission), including 4 14 (27.85%) group, 11 17 patients(64.71%) CNIs+RTX 18 27 (66.67%) (p=0.048). 51 patients(87.93%) (85.71%) 15 patients(88.24%) 24 (88.89%) (p=0.957). During 12-month study, 7 did not response treatment. 1 patient relapsed during re-elevation antibodies. Adverse occurred 18(31.03%)patients whole patients(5.17%) 2 patients(3.45%) 13patients(22.41%) group(p< 0.05). CONCLUSIONS can effectively alleviate first months，as well GC, efficacy both methods IMN superior alone Furthermore, side effects compared GC+CNIs group. So be recommended shorten remission durion