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Abstract Backround To investigate the efficacy of rituximab, tacrolimus, and cyclophosphamide on idiopathic membranous nephropathy (IMN) and the related factors for efficacy. Methods A total of 117 patients diagnosed with IMN by renal biopsy or positive anti-phospholipase antibody from January 2018 to December 2022, tacrolimus, cyclophosphamide, or rituximab were selected as initial immunotherapy. The remission of proteinuria and infection were followed up. Survival analysis was used to explore the difference in the remission rate of proteinuria among the three groups, and Cox regression model was used to explore the risk factors of IMN treatment effect, and the difference in infection among the three groups was compared. ResultsAmong the 117 IMN patients, tacrolimus, cyclophosphamide and rituximab were selected for initial immunotherapy in 32, 63, and 22 patients, respectively.In the tacrolimus group, the total response rate of proteinuria at 6 months was 84.4%, the median response time was 3 months, and the complete response rate of proteinuria was 44.4%. The total remission rate of proteinuria was 82.5%, the median remission time was 5 months, and the complete remission rate of proteinuria was 40.9% in the cyclophosphamide group. The total remission rate of proteinuria at 6 months in the rituximab group was 72.7%, the median response time was 6 months, and the complete response rate of proteinuria was 42.9%. Multivariate Cox regression analysis showed that: In the first 6 months of initial treatment, the regimen affected on total renal response(HR=0.67, 95%CI 0.48-0.93, P= 0.02), and TAC had a better effect than RTX (HR=2.14, 95%CI 1.01-4.19, P=0.03). There was no difference between CTX and RTX. Serum albumin level at immunotherapy had a statistical effect on total renal response (HR=1.05, 95%CI 1.00-1.09, P = 0.04), and patients with serum albumin > 20g/L at immunotherapy had a better overall renal response rate. Conclusion The therapeutic effect of IMN was affected by the treatment regimen and the onset of serum albumin. Tacrolimus had a better effect than rituximab, and there was no difference between tacrolimus and cyclophosphamide. There was no difference in infection among the three groups.
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