Efficacy and safety of rituximab in patients with PLA2R associated membranous nephropathy and HCV infection

Abstract Background: Rituximab has become one of the first-line therapies for the treatment of phospholipase A2 receptor (PLA2R) associated membranous nephropathy (MN). However, there is a lack of studies to report the effectiveness and safety of rituximab in patients with PLA2R associated MN and Hepatitis C virus (HCV) infection, which is the aim of this study. Methods: We performed a single center retrospective review of 8 consecutive PLA2R associated MN patients with HCV infection. We assessed clinical and laboratory indices, remission rates, and adverse events at rituximab infusion, month 6, month 12, and last visit. Results: A total of 8 patients were enrolled, with a median follow-up period of 19.00 (16.00, 25.25) months. Of the 8 patients, 5 were male, and mean age was 50.13±4.29 years. At last visit, 5 (62.50%) patients achieved complete remission, and 7 (87.50%) patients achieved complete or partial remission. All 8 patients with HCV infection received antiviral agents and the load of HCV virus were undetectable at the time of rituximab treatment. No adverse effect of rituximab on HCV plasma viremia or hepatic transaminase levels was observed during the follow-up. Conclusions: This study suggested that on the basis of successful eradication of HCV virus with antiviral drugs, rituximab can effectively induce clinical remission of patients with PLA2R associated MN and HCV infection, and does not lead to a significant increase in HCV virus load. However, this finding is based on a very small sample size and should be confirmed in larger clinical trials.