Treatment strategies for rituximab-resistant primary membranous nephropathy: from resistance mechanisms to emerging therapies

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Rituximab resistance in primary membranous nephropathy (PMN) is multifactorial, involving anti-drug antibodies and incomplete B cell depletion.
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Emerging therapies for RTX-resistant PMN include next-generation anti-CD20 antibodies and advanced immune-engineering approaches like CAR-T.
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Current treatment strategies for PMN are shifting from broad immunosuppression to targeted interventions based on identified pathogenic mechanisms.
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Approximately 35% of PMN patients do not respond to RTX, with a recurrence rate of 27% after treatment, highlighting the need for personalized strategies.
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A novel classification framework for PMN focuses on target antigen identification to enhance precision medicine in diagnosis and treatment.

Frontiers In Immunology

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