Objective  To explore the efficacy and safety of obinutuzumab (OBZ) for phospholipase A2 receptor（PLA2R）-associated membranous nephropathy (MN) with an intermediate-to-high risk of progression.

Methods From January 2022 to November 2022, ten patients with a diagnosis of primary membranous nephropathy (PMN) received OBZ treatment. Baseline profiles, medical history, 24 hours urinary total protein (24 hUTP), blood biochemistry, cellular immunity, humoral immunity and other parameters were recorded and statistically analyzed by Graphpad Prism 9.4.1 software. Descriptions of \bar x ± s deviation were utilized for conforming to the measurements. Statistical comparisons of inter-group differences were made by non-parametric test of paired samples.

Results Renal partial response (PR) and complete response (CR) were defined according to the criteria of Kidney Disease: Improving Global Outcomes (KDIGO). Four cases achieved PR at Month 1. There were PR (n=6) and CR (n=1) at Month 6 and PR (n=1) and CR (n=7) at Month 14. PR+CR remission rate of 80%. Safety: 7 cases had no infusion reaction, 3 cases developed infusion reaction after an initial infusion of OBZ and all of them successfully completed treatment. Adverse reactions: 3 cases had complications of infection within 1 month after OBZ dosing. However, infections were cured.

Conclusion OBZ offers better therapeutic effect on PLA2R-associated MN with fewer adverse reactions and better safety.