Critical Reappraisal of Obinutuzumab Randomized Trials in Membranous Nephropathy
Piero Ruggenenti, Matias Trillini, Manuel Alfredo Podestà, Giuseppe Remuzzi · 2026
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Description
Ruggenenti and team write, in 2026, a letter reappraising two trials of obinutuzumab as first-line therapy for primary membranous nephropathy, a kidney disease causing nephrotic syndrome. They question the comparator arms. The MAJESTY trial pits the anti-CD20 antibody against tacrolimus in 142 patients, and the BEGIN trial against cyclosporine in 155 participants, though calcineurin inhibitor monotherapy is no longer recommended care.
Their argument rests on the earlier MENTOR trial, which showed rituximab clearly superior to cyclosporine, leading 2021 KDIGO guidelines to make rituximab first-line for high-risk patients. On that evidence, they contend any new agent should be tested against a rituximab-based standard, not a superseded drug. Otherwise approval may rest on beating a straw comparator. They also note cost counterarguments are weaker than assumed: B-cell-driven dosing protocols can cut rituximab cost up to fourfold, and biosimilars could halve it again.
Catalog record
| CREATOR | Piero Ruggenenti, Matias Trillini, Manuel Alfredo Podestà, Giuseppe Remuzzi |
|---|---|
| YEAR | 2026 |
| COLLECTION | PAPERS |
| FORMAT | TXT |
| FILE SIZE | 3 KB |
| VERSION | 1.0 |
| LICENSE | CC BY 4.0 |
| RIGHTS | CC BY |
| SOURCE | Europe PMC |