A retrospective study of rituximab or Tacrolimus combined with glucocorticoid for idiopathic membranous nephropathy

Objective To compare the efficacy and safety of rituximab or tacrolimus combined with glucocorticoid for treatment of idiopathic membranous nephropathy. Methods The patients with idiopathic membranous nephropathy treated with rituximab combined with low-dose hormone (rituximab group) and tacrolimus combined with low-dose glucocorticoid (tacrolimus group) respectively in Department of Nephropathy of Chinese PLA General Hospital from March 2014 to March 2018 were selected. The changes of 24-hour urinary protein content, serum albumin and creatinine levels in the two groups before treatment, and at 1 month, 3 months, 6 months and 12 months of treatment were observed to assess the total remission rate. Adverse reactions were observed. Results A total of 149 subjects were included in the study, including 62 patients in the rituximab group and 87 patients in tacrolimus group. There were no significant differences in age, gender, 24 h urine protein content, serum albumin and serum creatinine before treatment between the two groups (P>0.05).After 12 months of treatment, the total remission rate with the rituximab group (70.97%) was not significantly different from that with the tacrolimus group (64.37%) (P>0.05), but the recurrence rate with the rituximab group was much lower than that with the tacrolimus group (P<0.01). The 24-hour urine protein of the two groups was significantly lower than that before treatment (P<0.01). Serum albumin levels all were improved compared with those before treatment(P<0.01), and the improvement rates of 24 h urine protein content and serum albumin level in the two groups were similar with no statistically significant difference (P>0.05). In term of changes of serum creatinine, there was no significant difference compared with that before treatment in the rituximab group (P>0.05), with the overall stable kidney function. In the tacrolimus group, serum creatinine after treatment increased compared with that before treatment, suggesting damage of renal functions, In terms of adverse reactions, the rituximab group mainly showed infection and infusion reaction, while the tacrolimus group showed infection, liver and kidney function damage, elevated blood glucose, gastrointestinal reaction, and hair loss. For the rituximab group, there were fewer adverse reaction types and patients with adverse reactions. Conclusions Both rituximab and tacrolimus are effective in alleviating membranous nephropathy and reducing proteinuria, but compared with tacrolimus, rituximab has the advantages of low adverse reactions, low recurrence rate and low cost, and is expected to be a first-line drug.