Outcomes and Predictors of Treatment Response in Patients With Pure Lupus Membranous Nephropathy
Abstract
Introduction The indications and modalities of therapeutic strategies for first-onset pure lupus membranous nephropathy (PLMN) remain poorly defined. We aimed to evaluate renal response rates across real-world treatment strategies and identify predictors of treatment response in PLMN. Methods We conducted a multicenter retrospective study in 25 French centers. Patients with biopsy-proven first-onset PLMN treated between 2000 and 2020 were included. Patients were classified according to their initial treatment strategy. Renal response rates were defined based on the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Factors associated with treatment failure at 12 months were assessed using logistic regression. Results Among 194 patients with PLMN, 53 (27.3%) received supportive care only, and 141 (72.7%) received immunosuppressive therapy (54 [38.3%] received mycophenolate mofetil (MMF)-based regimens, 26 [18.4%] received rituximab [RTX]-based regimens, and 61 [43.3%] received other treatments). At 12 months, rates of complete renal response (CRR) and CRR or partial renal (PRR) were respectively, 36.7% and 55.1% with supportive care, 47.1% and 60.8% with MMF, 64.0% and 72.0% with RTX, and 45.4% and 54.5% with other regimens. In multivariable analysis, the presence of anti–U1-ribonucleoprotein (U1RNP) antibodies was independently associated with treatment failure (adjusted odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.35–4.70; P = 0.004), whereas extrarenal lupus involvement was protective (adjusted OR=0.39; 95% CI: 0.19–0.73; P = 0.004). RTX-based regimens were significantly associated with shorter treatment duration and corticosteroid sparing. Conclusion In patients with first-onset PLMN, 12-month renal response rates did not differ significantly among immunosuppressive regimens despite variation in treatment duration and steroid exposure. Anti-U1RNP antibodies and absence of extrarenal involvement were associated with a higher risk of treatment failure. Anti-CD20–based strategies may be a promising therapeutic approach.
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BibTeX
@article{chevalier2026outcomes,
title = {{Outcomes and Predictors of Treatment Response in Patients With Pure Lupus Membranous Nephropathy}},
author = {Kevin Chevalier and Romain Brousse and Alexandre Karras and Nathalie Costedoat-Chalumeau and Julien Dang and Maxence Tailliar and Noémie Jourde-Chiche and Charles Ronsin and Moglie Le Quintrec-Donnette and Marie Julien and Stanislas Faguer and Aymeric Couturier and Pierre Pommerolle and Céline Lebas and Antoine Coussement and Marion Chapal and Christophe Barba and Alexia Gauffre and Maxime Teisseyre and Johan Noble and Chloé Comarmond and Eve Vilaine and Jean-François Augusto and Aurélie Hummel and Évangéline Pillebout and Jean-Michel Halimi and Olivier Moranne and Eric Daugas and Jean-Jacques Boffa and Emmanuel Esteve},
journal = {Kidney International Reports},
year = {2026},
month = oct,
doi = {10.1016/j.ekir.2026.106678},
url = {https://hal.science/hal-05792957v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Outcomes and Predictors of Treatment Response in Patients With Pure Lupus Membranous Nephropathy
AU - Kevin Chevalier
AU - Romain Brousse
AU - Alexandre Karras
AU - Nathalie Costedoat-Chalumeau
AU - Julien Dang
AU - Maxence Tailliar
AU - Noémie Jourde-Chiche
AU - Charles Ronsin
AU - Moglie Le Quintrec-Donnette
AU - Marie Julien
AU - Stanislas Faguer
AU - Aymeric Couturier
AU - Pierre Pommerolle
AU - Céline Lebas
AU - Antoine Coussement
AU - Marion Chapal
AU - Christophe Barba
AU - Alexia Gauffre
AU - Maxime Teisseyre
AU - Johan Noble
AU - Chloé Comarmond
AU - Eve Vilaine
AU - Jean-François Augusto
AU - Aurélie Hummel
AU - Évangéline Pillebout
AU - Jean-Michel Halimi
AU - Olivier Moranne
AU - Eric Daugas
AU - Jean-Jacques Boffa
AU - Emmanuel Esteve
PY - 2026
DA - 2026/10/11
JO - Kidney International Reports
DO - 10.1016/j.ekir.2026.106678
UR - https://hal.science/hal-05792957v1
AB - Introduction The indications and modalities of therapeutic strategies for first-onset pure lupus membranous nephropathy (PLMN) remain poorly defined. We aimed to evaluate renal response rates across real-world treatment strategies and identify predictors of treatment response in PLMN. Methods We conducted a multicenter retrospective study in 25 French centers. Patients with biopsy-proven first-onset PLMN treated between 2000 and 2020 were included. Patients were classified according to their initial treatment strategy. Renal response rates were defined based on the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Factors associated with treatment failure at 12 months were assessed using logistic regression. Results Among 194 patients with PLMN, 53 (27.3%) received supportive care only, and 141 (72.7%) received immunosuppressive therapy (54 [38.3%] received mycophenolate mofetil (MMF)-based regimens, 26 [18.4%] received rituximab [RTX]-based regimens, and 61 [43.3%] received other treatments). At 12 months, rates of complete renal response (CRR) and CRR or partial renal (PRR) were respectively, 36.7% and 55.1% with supportive care, 47.1% and 60.8% with MMF, 64.0% and 72.0% with RTX, and 45.4% and 54.5% with other regimens. In multivariable analysis, the presence of anti–U1-ribonucleoprotein (U1RNP) antibodies was independently associated with treatment failure (adjusted odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.35–4.70; P = 0.004), whereas extrarenal lupus involvement was protective (adjusted OR=0.39; 95% CI: 0.19–0.73; P = 0.004). RTX-based regimens were significantly associated with shorter treatment duration and corticosteroid sparing. Conclusion In patients with first-onset PLMN, 12-month renal response rates did not differ significantly among immunosuppressive regimens despite variation in treatment duration and steroid exposure. Anti-U1RNP antibodies and absence of extrarenal involvement were associated with a higher risk of treatment failure. Anti-CD20–based strategies may be a promising therapeutic approach.
SN - 2468-0249
ER -