Recent Progress in Deciphering the Etiopathogenesis of Primary Membranous Nephropathy

Table 4

Effects of treatment on PLA2R-Ab and variables of interest have been highlighted. The study by Wang et al. [39] included nonnephrotic patients only and all patients received nonimmunosuppressive treatment with inhibition of the renin angiotensin aldosterone system.

Reference	Country	Number of patients	Treatment	Effect of treatment
[40]	USA	25	Rituximab	17/25 had undetectable Ab levels within 12 months; 59/88% attained remission by 12 and 24 months (compared to 0/33% in those with persistent PLA2R-Ab)
[41]	Netherlands	33	MMF, ; CYC,	16/18 became Ab negative during 12 months of CYC versus 8/15 in the MMF group (); In general, remission was observed in 22/24 negative patients versus 3/9 positive patients at 12 months; Antibody status at the end of therapy predicted long-term outcome (persistent remission and alternative outcome measures)
[38]	France	55	Rituximab, ; Placebo,	PLA2R-Ab negativity: 14/25 and 13/26 at months 3 and 6 in the rituximab group; 1/23 and 3/25 at months 3 and 6 in the placebo group; In the rituximab group, antibody depletion at month 3, 6 patients (43%) were associated with the primary end point (complete/partial remission), with 2/11 patients (18%) without antibody depletion
[37]	Italy	81	Rituximab	Low titer of PLA2R-Ab predicted achievement of primary end point (complete or partial remission, ); PLA2R-Ab promptly decreased and preceded a comparable proteinuria response by approximately 2 years; Depletion of PLA2R-Ab after 6 months predicted primary end point; Reappearance of antibodies was associated with relapse ()
[19]	Netherlands	18	MMF or CYC	PLA2R-Ab decreased significantly during remission and increased again during relapse ()
[20]	Germany	133	CNI, alkylating agents or rituximab	Decrease in proteinuria was accompanied by an increase in serum albumin (); At 3 months, proteinuria fell by 25%, whereas PLA2R-Ab levels decreased by 45%; PLA2R-Ab levels as a risk factor for not achieving remission
[22]	India	76	CNI or CYC	>90% reduction in PLA2R-Ab titer at 12 months from baseline, accompanied by remission in 85% (<50% Ab reduction, 88% had persistent nephrotic range proteinuria); Proteinuria (, each) and serum albumin ( and ) correlated with PLA2R-Ab titer at 6 and 12 months; A greater proportion of subjects in the first two tertiles had complete remission compared with patients in the highest tertile ()
[42]	Germany	16		In initially nonnephrotic patients, nephrotic range proteinuria developed more often in PLA2R-Ab positive patients (); Significantly more PLA2R-Ab positive patients received immunosuppressive therapy ()