Comparison of the efficacy of Obinutuzumab versus Rituximab combined with tacrolimus in the treatment of refractory membranous nephropathy

Background Primary membranous nephropathy (pMN) is often prolonged, relapse-prone, and drug-resistant. While obinutuzumab (OBI) shows promising efficacy, its direct comparison with rituximab (RTX) plus tacrolimus (TAC) is lacking, necessitating more clinical evidence for OBI's application. Methods Baseline data from patients with refractory membranous nephropathy treated with either OBI (OBI group) or RTX combined with TAC (RTX + TAC group) were retrospectively collected from the Department of Nephrology at the First Affiliated Hospital of the Naval Medical University. The data included demographic information, laboratory values at key time points, treatment outcomes, and adverse events. Statistical methods were employed to compare the differences between the two groups and to analyze trends in clinical remission, leading to the final conclusions. Results A total of 28 patients received either OBI (n = 15) or RTX + TAC (n = 13). No significant differences were observed in age, gender, 24-hour urine protein, or cumulative prior RTX use at baseline. However, disease duration was significantly longer in the OBI group (87.7 ± 66.3 months) compared to the RTX + TAC group (14 (7, 36) months). At 12 months, clinical remission rates were 100% with OBI and 42.85% with RTX + TAC; immunologic remission rates were 75% and 22.8%, respectively. No significant difference was found in adverse event incidence between the groups. Conclusion OBI can effectively alleviate refractory membranous nephropathy (MN), and its adverse reaction rate is not significantly different compared to RTX + TAC, while it is more convenient than RTX + TAC, which is expected to become the first-line therapeutic drug for refractory membranous nephropathy.