Objective: To compare the clinical efficacy and safety of rituximab (RTX) combined low-dose glucocorticoid for idiopathic membranous nephropathy (IMN).

Methods: A total of 35 IMN patients were recruited from July，2019 to December, 2023. Control group (n=19): CTX combined glucocorticoid. Experimental group (n=26): rituximab combined low-dose glucocorticoid. The differences of 24-hour urinary protein, serum albumin, blood creatinine, anti-PLA2R antibody titer, disease re-mission rate and adverse reactions were compared between two groups before and at different timepoints post-treatment.

Results: No significant inter-group differences existed in gender, age, body mass index, blood pressure, 24-hour urinary protein, serum albumin, blood creatinine, eGFR or anti-PLA2R antibody count pre-treatment (P>0.05). At Month 6, 24-hour urinary protein declined markedly in 2 groups as compared with pre-treatment (P<0.01); serum level of albumin spiked markedly as compared with pre-treatment (P<0.01). However, no significant inter-group difference existed in reduction of urinary protein and recovery of serum albumin post-treatment (P>0.05). In terms of serum creatinine, total renal function of 2 groups remained stable without statistical significance (P>0.05). Anti-PLA2R-Ab level declined markedly in two groups post-treatment as compared with pre-treatment and the difference was not statistically significant (P>0.05). In terms of disease remission, total effective rate reached 71.43% at Month 6. Meanwhile, recurrence rate was no significant inter-group difference existed in adverse reactions (P>0.05).

Conclusion: With a higher clinical remission rate without a higher incidence of adverse reactions, RTX combined low-dose glucocorticoid is more suitable for treating IMN. However, adverse reactions causing severe hypokalemia deserve greater attention