膜性肾病抗利妥昔单抗抗体相关治疗失败后的奥比努珠单抗：病例报告
Obinutuzumab after anti-rituximab antibody-associated treatment failure in membranous nephropathy: a case report.
摘要(中文译文)
利妥昔单抗是原发性膜性肾病的既定治疗方法，但抗利妥昔单抗抗体（ARA）与利妥昔单抗治疗失败相关。我们报告一例66岁女性PLA2R阳性膜性肾病患者，该患者出现ARA阳性及符合利妥昔单抗治疗失败的临床特征，包括B细胞重建、血清利妥昔单抗水平不可测及蛋白尿恶化，尽管抗PLA2R抗体滴度下降。肾活检证实为III期膜性肾病。随后她接受了人源化II型抗CD20抗体奥妥珠单抗治疗，该治疗诱导循环B细胞完全耗竭，达到治疗性血清浓度，并在8.5个月内实现免疫学和临床缓解，尽管ARA持续阳性。本病例提示，在ARA相关的利妥昔单抗治疗失败后，奥妥珠单抗可能是一种有效的挽救治疗选择，并强调了在难治性膜性肾病管理中整合治疗药物监测、ARA检测和B细胞动力学评估的重要性。
Abstract
Rituximab is an established therapy for primary membranous nephropathy, but anti-rituximab antibodies (ARA) have been associated with rituximab treatment failure. We report a 66-year-old woman with PLA2R-positive membranous nephropathy who developed ARA positivity and clinical features consistent with rituximab treatment failure, including B-cell reconstitution, undetectable serum rituximab levels, and worsening proteinuria despite declining anti-PLA2R antibody titers. Kidney biopsy confirmed stage III membranous nephropathy. She was subsequently treated with the humanized type II anti-CD20 antibody obinutuzumab, which induced complete depletion of circulating B cells, achieved therapeutic serum concentration, follow by both immunological and clinical remission within 8.5 months, despite persistent ARA positivity. This case suggests that obinutuzumab may be an effective rescue option after rituximab failure associated with ARA and underscores the importance of integrating therapeutic drug monitoring, ARA detection, and B-cell kinetics assessment in the management of refractory membranous nephropathy.
如何引用
AMA
Jianying Guo, Anni Zhong, Di Wu, Yang Liu, Yuna Chen, Yi Xu, et al. Obinutuzumab after anti-rituximab antibody-associated treatment failure in membranous nephropathy: a case report.. Frontiers in immunology. 2026; doi:10.3389/fimmu.2026.1758250.
APA
Jianying Guo, Anni Zhong, Di Wu, Yang Liu, Yuna Chen, Yi Xu, et al (2026). Obinutuzumab after anti-rituximab antibody-associated treatment failure in membranous nephropathy: a case report.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1758250
GB/T 7714
Jianying Guo, Anni Zhong, Di Wu, Yang Liu, Yuna Chen, Yi Xu, et al. Obinutuzumab after anti-rituximab antibody-associated treatment failure in membranous nephropathy: a case report.[J]. Frontiers in immunology, 2026 doi:10.3389/fimmu.2026.1758250.
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