Bortezomib plus dexamethasone for rituximab-resistant PLA2R+ membranous nephropathy

Although 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.