Would you consider using a combination regimen of rituximab, low-dose cyclophosphamide, and steroids to improve complete remission rates in patient with PLA2R-positive membranous nephropathy?

Patients with membranous nephropathy (MN) with declining GFR, not explained by causes other than MN, massive proteinuria, and high-titer anti-PLA2R antibodies are considered high risk and should be treated with immunosuppressive therapy. Both the Membranous Nephropathy Trial of Rituximab (MENTOR) (1...

Personally, I have never used a combination of rituximab, low-dose cyclophosphamide, and steroids for PLA2R membranous nephropathy. In high-risk membranous nephropathy with life-threatening nephrotic syndrome and rapidly dropping GFR, cyclophosphamide is recommended over rituximab. The half-life of ...