Clinical Observation of Obinutuzumab Combined with Abelmoschus manihot Tablets in the Treatment of Idiopathic Refractory Membranous Nephropathy

Context: Idiopathic refractory membranous nephropathy (IRMN) often progresses to ESRD with limited therapeutic options. Consequently, the development of novel and effective therapies for IRMN represents an urgent unmet need in the field of nephrology. Objective This study evaluated the efficacy and safety of combining Obinutuzumab and Abelmoschus manihot tablets for IRMN, hypothesizing synergistic actions targeting CD20 + B cells apoptosis and inflammation. Methods Thirty-one IRMN patients received combined therapy and were followed for 12 months. Primary endpoint was remission rate (complete/partial). Secondary outcomes included biochemical and immunological parameters and adverse events. Results At 12 months, the overall remission rate was 80% (complete: 16%; partial: 64%). Median time to remission was 4.5 months (IQR 2.0–7.0). Immunological remission rates were 70% (3m), 83% (6m), 90% (9m), and 93% (12m). Anti-PLA2R antibodies declined rapidly within 3 months in 80% of patients ( p  < 0.001); 64% achieved ≥ 50% reduction by month 3. Antibodies became undetectable in all patients by final follow-up. Adverse events were infusion-related reactions (fever, hypotension, tachycardia, flushing). No deaths occurred. Conclusion The Obinutuzumab and Abelmoschus manihot tablets combination induced high remission rates in IRMN, with rapid immunological response and a tolerable safety profile, representing a novel therapeutic approach.