Work

Treatment‐Line‐Specific Outcomes of Obinutuzumab in Membranous Nephropathy: A Systematic Review and Meta‐Analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background: Primary membranous nephropathy (PMN) is an autoimmune glomerulonephritis triggered by B-cell dysfunction, where rituximab achieved clinical remission in about 55%-65% of patients, while 35%-45% of patients are nonresponders. Obinutuzumab, a humanized type II anti-CD20 monoclonal antibody that showed more profound B-cell depletion, may improve treatment outcomes in both treatment-naïve and refractory patients. This systematic review and meta-analysis evaluate the clinical and immunological outcomes of obinutuzumab in PMN. Methods: We performed a systematic literature search across PubMed, Scopus, and Web of Science through January 2026 to identify studies assessing the effect of obinutuzumab in PMN. We performed meta-analyses using the meta package in R software. Results: As first-line therapy, pooled complete response was 0.324, rising from 0.257 at 6 months to 0.485 at 12 months, and partial response was 0.508. Clinical remission and immunological response were both high ranging between 81% and 89%. As second-line therapy after rituximab, complete response was lower (18.1%) but partial response remained high (54.7%), with clinical remission increasing to 83.5% at 12 months and immunological response improving significantly to 90.5% at 12 months. In rituximab-refractory patients, complete and partial response rates were 27.8% and 54.3%, respectively, with clinical remission improving notably by 12 months (84.5%). Secondary analyses showed increased serum albumin and reduced proteinuria over time. Conclusion: Obinutuzumab was associated with clinical and immunological remission in PMN. Clinical and immunological responses were observed across treatment-naïve, previously treated, and rituximab-refractory populations, though differences between these nonrandomized treatment-line groups should not be interpreted as comparative efficacy. No clear short-term change in kidney-function measures was detected.

Source: International Journal of Nephrology

DOI: 10.1155/ijne/6372570