Low dose Rituximab monotherapy or in combination with Tacrolimus is effective in primary membranous nephropathy

The Membranous Nephropathy Trial of Rituximab study demonstrated that rituximab was noninferior to cyclosporine in inducing complete remission (CR) or partial remission (PR) of primary membranous nephropathy (MN) using an induction dose of 1000 mg on day 1 and another 1000 mg on day 15 (1). Prior studies of rituximab demonstrated remission using lower doses (2,3). We present 22 patients who received low-dose rituximab monotherapy or in combination with tacrolimus to achieve CR or PR for MN. Retrospective chart review was conducted for 22 patients aged 28–72 years who underwent treatment for MN from 2014 to 2019. Patients whose GFR was <40 ml/min per 1.73 m2 were excluded. Five patients previously received immunosuppression. Patient 14 received modified Ponticelli regimen without response. His medications were stopped 2 months before starting rituximab therapy. Patient nine and Patient 17 were treated with tacrolimus and steroids without response. Patient 17 stopped his medications 6 months before starting rituximab therapy. Patient 9 stopped his medications 2 months before starting rituximab therapy. Patient 11 and Patient 22 achieved remission with steroids and tacrolimus but relapsed. Patient 11 relapsed 1 year after stopping medications and Patient 22 …