Randomized, open label, multicentre (20 sites), prospective trial comparing the efficacy of
two therapeutic strategies to obtain clinical remission 1 year after diagnosis of Idiopathic
Membranous Nephropathy with nephrotic syndrome and anti-PLA2R1 (phospholipase A2 receptor 1)
antibodies:
- GEMRITUX protocol: 6 months of symptomatic antihypertensive and antiproteinuric therapy,
and if the nephrotic syndrome persists at month-6 (urinary protein/creatinine ratio
(UPCR) remains > 3.5 g/g and albuminemia < 30 g/l), two 375 mg/m2 rituximab infusions at
1-week interval.
- Personalized treatment:
- restricted anti-CysR activity at inclusion : 6-month symptomatic antihypertensive
and antiproteinuric treatment (KDIGO)
- restricted anti-CysR activity after 6 months of symptomatic treatment with
persisting nephrotic syndrome (UPCR remains > 3.5 g/g and albuminemia < 30 g/l):
two 375 mg/m2 rituximab infusions at 1-week interval;
- Anti-CTLD (C-type lectin domains ) 1/7 activity at inclusion or after 6 months with
persisting nephrotic syndrome (UPCR remains > 3.5 g/g and albuminemia < 30 g/l):
two 1g rituximab infusions at 2-week interval at month 0 and/or month 6.