Efficacy and safety of rituximab therapy for membranous nephropathy: a meta-analysis.

OBJECTIVE: Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults, but the treatment of MN remains controversial. Rituximab, a possible alternative treatment option, represented a new therapeutic hope for the treatment of membranous nephropathy (MN). We performed a meta-analysis to perform the efficacy and safety of rituximab therapy.

MATERIALS AND METHODS: Either randomized controlled trials (RCTs), cohort studies or case studies were eligible for review and were performed in Medline, Embase, Web of Science, Cochrane database with the computerized searches. The primary outcome measure was remissions and the endpoint outcomes. We assessed the following studies methodological quality independently by using the Cochrane Collaboration tool for assessing risk of bias scale. The primary meta-analyses were performed using fixed or random effects models due to a1n expected clinical diversity.

RESULTS: Five trials with a total of 351 patients were included. We found significant difference between rituximab and the placebo group on complete remissions rate (OR=1.6, 95%; CI=0.96, 2.66; I2 of 0% indicating no heterogeneity) and eGFR (MD=-0.69, 95% CI=-14.53, 0.73). The factors of remission and no remission MN patients who received treatment with rituximab on remission were proteinuria and albumin, which reported different (MD=7.20, 95% CI=-9.07, -5.33) (MD=10.70, 95% CI=7.23, 14.17). But remains high risk of infusion reactions (OR= 81.37, 95% CI=4.89, 1354.41). No evidence of significant risk of bias was reported.

CONCLUSIONS: Rituximab had a beneficial effect and remissions of proteinuria on MN during follow-up times, but some adverse events were still unknown. Taking consideration of long-term therapeutic side effects and dose of the drug, we suggest that rituximab might replace cyclophosphamide and steroids as first-line immunosuppressive therapy in MN patients.