{
  "abstract": "IntroductionB cell depletion with rituximab leads to complete or partial remission (CR/PR) in only [~]60% of patients with primary membranous nephropathy (PMN). Adding belimumab to rituximab may result in greater depletion of memory B cells, limit the re-emergence of autoreactive B cells, and improve clinical responses.\n\nMethodsREBOOT Part A (NCT03949855) is a single arm, open-label, pharmacokinetic study where all participants had proteinuria [≥] 4g/day and detectable serum anti-phospholipase A2 receptor (anti-PLA2R) antibodies. Participants received belimumab 200 mg subcutaneously weekly for 52 weeks and rituximab 1000 mg intravenously at weeks 4 and 6. Assessments included belimumab exposure at week 4 and CR/PR at week 104.\n\nResultsSeventeen participants started belimumab. Belimumab exposure was not significantly reduced in those with high (>8 g/day) proteinuria at week 4. Among all treated participants, 59% (10/17) achieved CR/PR at week 104, while in per protocol analyses, 91% (10/11) achieved CR/PR at week 104. All participants in per protocol analyses had normal serum albumin and undetectable serum anti-PLA2R by week 104. Circulating memory B cells increased before rituximab and were depleted by rituximab. B cell re-constitution occurred after week 52 with primarily naive and transitional B cells. Belimumab with rituximab was well-tolerated, with one participant discontinuing belimumab due to infection.\n\nConclusionIn this study, a high proportion of participants receiving belimumab with rituximab achieved CR/PR. Thus, a multi-targeted approach to B cell depletion may improve immunologic and clinical outcomes in PMN and is being studied in a larger, randomized, placebo-controlled clinical trial.",
  "abstract_shown": true,
  "affiliations": [
    "Immune Tolerance Network"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 18,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "S. A. Chung"
    },
    {
      "name": "L. Stelzig"
    },
    {
      "name": "M. A. Sherman"
    },
    {
      "name": "W. Gao"
    },
    {
      "name": "P. Tosta"
    },
    {
      "name": "L. A. Cooney"
    },
    {
      "name": "S. Adler"
    },
    {
      "name": "N. Aslam"
    },
    {
      "name": "I. Ayoub"
    },
    {
      "name": "A. S. Bomback"
    },
    {
      "name": "G. Coppock"
    },
    {
      "name": "V. K. Derebail"
    },
    {
      "name": "F. Kamal"
    },
    {
      "name": "D. V. Rizk"
    },
    {
      "name": "K. R. Tuttle"
    },
    {
      "name": "M. Waldman"
    },
    {
      "name": "W. T. Barry"
    },
    {
      "name": "P. H. Nachman"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3yrnkveabb888.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.08.26.26360913",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26360913v1.full",
  "id": "3yrnkveabb888",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26360913v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "nephrology"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26360913v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-26",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/3yrnkveabb888.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:24Z",
      "native_id": "10.64898/2026.08.26.26360913",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26360913v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:nephrology",
      "subfield": "general"
    }
  ],
  "title": "Belimumab with rituximab for the treatment of primary membranous nephropathy",
  "title_text": "Belimumab with rituximab for the treatment of primary membranous nephropathy",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:35Z",
  "url": "https://research.draconitic.com/paper/3yrnkveabb888",
  "venue": "medRxiv",
  "versions": [
    {
      "doi": "10.1016/j.ekir.2026.107075",
      "pid": "48ryh90cwgm1p",
      "relation": "published-as",
      "title": "Belimumab With Rituximab for the Treatment of Primary Membranous Nephropathy.",
      "venue": "Kidney international reports"
    }
  ]
}