Daratumumab for multidrug-resistant phospholipase-A2 receptor–related membranous nephropathy

At least 10% of patients with anti–phospholipase-A2 receptor antibody (aPLA2R)–associated membranous nephropathy do not attain immunologic remission with standard therapies. Anti–plasma cell therapy with bortezomib has been suggested. 1 Salhi S. Ribes D. Colombat M. et al. Bortezomib plus dexamethasone for rituximab-resistant PLA2R+ membranous nephropathy. Kidney Int. 2021; 100: 708-709 Google Scholar ,2 Geara A.S. Bhoj V. Hogan J.J. Bortezomib treatment for refractory PLA2R-positive membranous nephropathy. Glomerular Dis. 2021; 1: 40-43 Google Scholar We report the disease course in a patient treated with daratumumab, a human monoclonal anti-CD38 antibody approved for treatment of multiple myeloma and amyloid light-chain amyloidosis. Bortezomib plus dexamethasone for rituximab-resistant PLA2R+ membranous nephropathyKidney InternationalVol. 100Issue 3PreviewAlthough B-cell depletion with rituximab has shown promising results in patients with phospholipase-A2 receptor membranous nephropathy (PLA2R+ MN),1 some patients develop refractory MN owing to incomplete B-cell depletion or anti-PLA2R antibody production by plasma cells.2 The best therapeutic option (obinutuzumab3 or belimumab4) in these patients remains elusive. This led us to consider whether plasma cell–directed therapy may be used as salvage therapy in rituximab-resistant PLA2R+ MN. Full-Text PDF