Obinutuzumab in Membranous Nephropathy: A Metsa-analysis Including Individual Patient Data

Membranous nephropathy (MN) is a leading cause of nephrotic syndrome, and 20–30% of patients remain refractory to rituximab. We conducted a systematic review and meta-analysis to evaluate obinutuzumab's efficacy and safety in MN. PubMed, Embase, and Cochrane Library were searched through February 2026. Individual patient data (IPD), two-arm comparative, and single-arm proportion meta-analyses were performed. Twenty-one studies involving 598 patients were included. Ten studies (149 patients) contributed IPD, five compared obinutuzumab with rituximab (231 patients), and all 21 studies contributed to the single-arm analysis (463 obinutuzumab-treated patients). In IPD analysis, pooled complete/partial remission (CR/PR) and immunological remission rates were 85.9% and 90.7%, respectively, with negligible heterogeneity. Remission rates were consistent across treatment-history and rituximab-exposure subgroups. Compared with rituximab, obinutuzumab was associated with higher CR/PR (RR 1.48, 95%CI 1.12–1.95) and immunological response (RR 1.74, 1.15–2.65) rates. Single-arm analysis yielded a pooled CR/PR rate of 82.5% with additional observed remission rates during longer follow-up. Adverse events occurred in 32.9% of patients and were generally manageable. These findings suggest that obinutuzumab may represent a promising therapeutic option for MN, particularly in rituximab-refractory or relapsing disease. Prospective studies and longer-term safety data are needed before definitive conclusions can be drawn.