Efficacies of different doses of rituximab in the treatment of idiopathic membranous nephropathy and analysis of recurrence-influencing factors

doi:10.3760/cma.j.cn441417-20240814-05004

Abstract

Abstract:

Objective　To evaluate the efficacies of different doses of rituximab (RTX) in the treatment of idiopathic membranous nephropathy (IMN) and to identify factors influencing its recurrence. Methods　A retrospective analysis was conducted on 100 IMN patients treated at the Yulin Hospital of Xi'an Jiaotong University First Affiliated Hospital from June 2020 to June 2023, and were divided into two groups based on total medication dose. There were 35 males and 15 females in the study group, aged (56.39±10.73) years, with a body mass index of (25.31±2.36) kg/m², and there were 14 cases of hypertension, 12 cases of diabetes, and 11 cases of hyperlipidemia. In the control group, there were 37 males and 13 females, aged (57.21±10.80) years, with a body mass index of (25.74±2.52) kg/m², and there were 13 cases of hypertension, 14 cases of diabetes, and 12 cases of hyperlipidemia. Both the study group and the control group were treated with rituximab injection 375 mg/m² intravenously, once a week for 4 weeks in the control group, once every 2 weeks for 6 weeks in the study group. The clinical efficacies of the two groups were compared, as well as renal function [24 h urinary protein (24 h UP), serum creatinine (Scr), and estimated glomerular filtration rate (eGFR)] and immune function [M-type phospholipase A2 receptor (PLA2R) antibody, CD19 antigen-positive B (CD19+B) cells, and immunoglobulin G (IgG)] before and after treatment and adverse reactions during treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. After 1 year of follow-up, the recurrence rate was 22.00% (11/50) in the study group and 18.00% (9/50) in the control group, and the total recurrence rate was 20.00% (20/100). The patients were divided into a recurrence group (20 cases) and a non-recurrence group (80 cases); the influencing factors of recurrence in IMN patients were analyzed by univariate and multivariate logistic regression analysis. Results　The total effective rate was 60.00% (30/50) in the study group and 62.00% (31/50) in the control group, and the difference was not statistically significant (P>0.05). After treatment, there were no statistically significant differences in the 24 h UP, Scr, PLA2R antibody, IgG level, CD19+B cell proportion, and eGFR between the study group and the control group (all P>0.05). During treatment, the total incidence of adverse reactions in the study group was lower than that in the control group [34.00% (17/50) vs. 56.00% (28/50)] (P<0.05). Univariate analysis showed that there were statistically significant differences in the age, 24 h UP, Scr, PLA2R antibody, IgG level, and CD19+B cell proportion between the recurrence group and the non-recurrence group (all P<0.05). Multivariate logistic regression analysis showed that age ≥60 years old (OR: 7.679, 95%CI: 1.973-29.884), 24 h UP (OR: 2.319, 95%CI: 1.505-3.574), Scr (OR: 1.115, 95%CI: 1.016-1.223), PLA2R antibody (OR: 1.033, 95%CI: 1.001-1.065), and CD19+B cell proportion (OR: 1.031, 95%CI: 1.004-1.060) were all independent risk factors for recurrence in IMN patients, and IgG level (OR: 0.499, 95%CI: 0.265-0.941) was an independent protective factor (all P<0.05). Conclusions　Two different dosing regimens of RTX in the treatment of IMN showed no significant differences in overall clinical efficacy, renal function, or immune function indicators. However, the study group was more effective in reducing adverse reactions. Age, 24 h UP, Scr, PLA2R antibody, CD19+B cell proportion, and IgG level were important predictors of recurrence.

Key words:

Idiopathic membranous nephropathy, Rituximab, Clinical efficacy, Recurrence, Influencing factors

摘要：

目的　评估不同剂量利妥昔单抗治疗特发性膜性肾病（IMN）的效果，并分析复发影响因素。方法　选取2020年6月至2023年6月西安交通大学第一附属医院榆林医院收治的100例IMN患者作为研究对象，按治疗方案将患者分为研究组（50例）和对照组（50例）。研究组男35例，女15例；年龄（56.39±10.73）岁；体重指数（25.31±2.36）kg/m²；合并高血压史14例，合并糖尿病史12例，合并高脂血症史11例。对照组男37例，女13例；年龄（57.21±10.80）岁；体重指数（25.74±2.52）kg/m²；合并高血压史13例，合并糖尿病史14例，合并高脂血症史12例。研究组和对照组均采用利妥昔单抗治疗方案，每次静脉滴注利妥昔单抗注射液375 mg/m²。对照组每周1次，连续治疗4周。研究组每2周1次，连续治疗6周。比较两组临床疗效，治疗前后肾功能［24 h尿蛋白定量（24 h UP）、血肌酐（Scr）、肾小球滤过率估计值（eGFR）］、免疫功能［M型磷脂酶A2受体（PLA2R）抗体、CD19抗原阳性B（CD19+B）细胞、免疫球蛋白G（IgG）］，治疗期间不良反应发生情况。采用独立样本t检验、配对t检验和χ²检验进行统计学分析。随访1年后，研究组复发率为22.00%（11/50），对照组复发率为18.00%（9/50），总复发率为20.00%（20/100），将患者分为复发组（20例）和未复发组（80例）；采用单因素及多因素logistic回归分析IMN患者复发的影响因素。结果　研究组治疗总有效率为60.00%（30/50），对照组为62.00%（31/50），差异无统计学意义（P>0.05）。治疗后，研究组和对照组24 h UP、Scr、PLA2R抗体、IgG水平、CD19+B细胞比例和eGFR比较，差异均无统计学意义（均P>0.05）。治疗期间，研究组不良反应总发生率低于对照组［34.00%（17/50）比56.00%（28/50）］（P<0.05）。单因素分析显示，复发组和未复发组年龄、24 h UP、Scr、PLA2R抗体、IgG水平和CD19+B细胞比例比较，差异均有统计学意义（均P<0.05）。多因素logistic回归分析显示，年龄≥60岁（OR：7.679，95%CI：1.973～29.884）、24 h UP（OR：2.319，95%CI：1.505～3.574）、Scr（OR：1.115，95%CI：1.016～1.223）、PLA2R抗体水平（OR：1.033，95%CI：1.001～1.065）和CD19+B细胞比例（OR：1.031，95%CI：1.004～1.060）均是IMN患者复发的独立危险因素，IgG水平（OR：0.499，95%CI：0.265～0.941）为独立保护因素（均P<0.05）。结论　两种利妥昔单抗治疗方案效果相似，研究组安全性较好。年龄、24 h UP、Scr、PLA2R抗体、IgG水平和CD19+B细胞比例均是预测IMN复发的重要因素。

关键词:

特发性膜性肾病, 利妥昔单抗, 临床疗效, 复发, 影响因素

Si Yafang, Liu Yuyu, Cao Li.

Efficacies of different doses of rituximab in the treatment of idiopathic membranous nephropathy and analysis of recurrence-influencing factors [J]. International Medicine and Health Guidance News, 2025, 31(5): 723-728.

思雅芳刘瑜瑜曹丽.

不同剂量利妥昔单抗治疗特发性膜性肾病的效果及复发影响因素分析 [J]. 国际医药卫生导报, 2025, 31(5): 723-728.

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