The B-cell depleting agent obinutuzumab (Gazyva) was superior to the immunosuppressant tacrolimus in inducing remissions in primary membranous nephropathy, the global phase III MAJESTY trial showed.
By week 104, 37% of patients in the obinutuzumab group achieved complete remission -- defined as a urinary protein-to-creatinine ratio of 0.3 or lower alongside a stable estimated glomerular filtration rate (eGFR) -- compared with just 6% in the tacrolimus group (P<0.001).
The monoclonal antibody also improved overall response, defined as complete or partial remission (51% vs 13%, P<0.001), reported researchers led by Fernando Fervenza, MD, PhD, of the Mayo Clinic in Rochester, Minnesota.
"The benefit of obinutuzumab appeared to be consistent across all prespecified subgroups, including patients who were considered to be at higher risk for treatment failure," they wrote in the New England Journal of Medicine. The findings were simultaneously presented at the European Renal Association annual congress in Glasgow.
"Primary membranous nephropathy is the most common cause of idiopathic nephrotic syndrome in adults without diabetes," the authors noted.
