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Peer-reviewedCC BY 4.0International Journal of Nephrology

Treatment‐Line‐Specific Outcomes of Obinutuzumab in Membranous Nephropathy: A Systematic Review and Meta‐Analysis

  • Abdelrahman M. Elettreby1
  • Ahmed A. Abo Elnaga1
  • Faisal A. Al-Harbi2
  • Sayed Sayem3
  • Tamara Aburiash4
  • Alam Eldin Musa Mustafa5
  • Dina Khodeer6
  • Ahmed Mohamed Aboelkheir1
  • Mostafa Gamal7
7 affiliations
  1. 1Faculty of Medicine Mansoura University Mansoura Egypt mans.edu.eg
  2. 2Department of Medicine King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia kfshrc.edu.sa
  3. 3Department of Statistics Comilla University Cumilla 3506 Bangladesh cou.ac.bd
  4. 4Faculty of Medicine An-Najah National University Nablus State of Palestine najah.edu
  5. 5Department of Child Health College of Medicine King Khalid University Abha Saudi Arabia kku.edu.sa
  6. 6Department of Pharmacology College of Medicine Imam Mohammad Ibn Saud Islamic University (IMSIU) Riyadh 13317 Saudi Arabia imamu.edu.sa
  7. 7Clinical Nephrology and Kidney Transplantation Department Urology and Nephrology Center Mansoura University Mansoura Egypt mans.edu.eg
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Abstract

Background: Primary membranous nephropathy (PMN) is an autoimmune glomerulonephritis triggered by B‐cell dysfunction, where rituximab achieved clinical remission in about 55%–65% of patients, while 35%–45% of patients are nonresponders. Obinutuzumab, a humanized type II anti‐CD20 monoclonal antibody that showed more profound B‐cell depletion, may improve treatment outcomes in both treatment‐naïve and refractory patients. This systematic review and meta‐analysis evaluate the clinical and immunological outcomes of obinutuzumab in PMN.

Methods: We performed a systematic literature search across PubMed, Scopus, and Web of Science through January 2026 to identify studies assessing the effect of obinutuzumab in PMN. We performed meta‐analyses using the meta package in R software.

Results: As first‐line therapy, pooled complete response was 0.324, rising from 0.257 at 6 months to 0.485 at 12 months, and partial response was 0.508. Clinical remission and immunological response were both high ranging between 81% and 89%. As second‐line therapy after rituximab, complete response was lower (18.1%) but partial response remained high (54.7%), with clinical remission increasing to 83.5% at 12 months and immunological response improving significantly to 90.5% at 12 months. In rituximab‐refractory patients, complete and partial response rates were 27.8% and 54.3%, respectively, with clinical remission improving notably by 12 months (84.5%). Secondary analyses showed increased serum albumin and reduced proteinuria over time.

Conclusion: Obinutuzumab was associated with clinical and immunological remission in PMN. Clinical and immunological responses were observed across treatment‐naïve, previously treated, and rituximab‐refractory populations, though differences between these nonrandomized treatment‐line groups should not be interpreted as comparative efficacy. No clear short‐term change in kidney‐function measures was detected.

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Cite

BibTeXRIS
BibTeX
@article{elettreby2026treatmentlinespecific,
  title = {{Treatment‐Line‐Specific Outcomes of Obinutuzumab in Membranous Nephropathy: A Systematic Review and Meta‐Analysis}},
  author = {Abdelrahman M. Elettreby and Ahmed A. Abo Elnaga and Faisal A. Al-Harbi and Sayed Sayem and Tamara Aburiash and Alam Eldin Musa Mustafa and Dina Khodeer and Ahmed Mohamed Aboelkheir and Mostafa Gamal},
  journal = {International Journal of Nephrology},
  year = {2026},
  month = nov,
  doi = {10.1155/ijne/6372570},
  url = {https://doi.org/10.1155/ijne/6372570},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Treatment‐Line‐Specific Outcomes of Obinutuzumab in Membranous Nephropathy: A Systematic Review and Meta‐Analysis
AU  - Abdelrahman M. Elettreby
AU  - Ahmed A. Abo Elnaga
AU  - Faisal A. Al-Harbi
AU  - Sayed Sayem
AU  - Tamara Aburiash
AU  - Alam Eldin Musa Mustafa
AU  - Dina Khodeer
AU  - Ahmed Mohamed Aboelkheir
AU  - Mostafa Gamal
PY  - 2026
DA  - 2026/11/09
JO  - International Journal of Nephrology
DO  - 10.1155/ijne/6372570
UR  - https://doi.org/10.1155/ijne/6372570
AB  - Background: Primary membranous nephropathy (PMN) is an autoimmune glomerulonephritis triggered by B‐cell dysfunction, where rituximab achieved clinical remission in about 55%–65% of patients, while 35%–45% of patients are nonresponders. Obinutuzumab, a humanized type II anti‐CD20 monoclonal antibody that showed more profound B‐cell depletion, may improve treatment outcomes in both treatment‐naïve and refractory patients. This systematic review and meta‐analysis evaluate the clinical and immunological outcomes of obinutuzumab in PMN.  Methods: We performed a systematic literature search across PubMed, Scopus, and Web of Science through January 2026 to identify studies assessing the effect of obinutuzumab in PMN. We performed meta‐analyses using the meta package in R software.  Results: As first‐line therapy, pooled complete response was 0.324, rising from 0.257 at 6 months to 0.485 at 12 months, and partial response was 0.508. Clinical remission and immunological response were both high ranging between 81% and 89%. As second‐line therapy after rituximab, complete response was lower (18.1%) but partial response remained high (54.7%), with clinical remission increasing to 83.5% at 12 months and immunological response improving significantly to 90.5% at 12 months. In rituximab‐refractory patients, complete and partial response rates were 27.8% and 54.3%, respectively, with clinical remission improving notably by 12 months (84.5%). Secondary analyses showed increased serum albumin and reduced proteinuria over time.  Conclusion: Obinutuzumab was associated with clinical and immunological remission in PMN. Clinical and immunological responses were observed across treatment‐naïve, previously treated, and rituximab‐refractory populations, though differences between these nonrandomized treatment‐line groups should not be interpreted as comparative efficacy. No clear short‐term change in kidney‐function measures was detected.
SN  - 2090-214X
SN  - 2090-2158
ER  -