A Review of Therapy for Primary Membranous Nephropathy Post-MENTOR

Primary membranous nephropathy (PMN) is the most common cause of nephrotic syndrome in adults worldwide. Recent evidence confirms an autoimmune pathogenesis highlighted by the discovery of the phospholipase A2 receptor (PLA2R) antigen. PLA2R serves as both a marker and a guide for treatment. Traditional treatments, including alkylating agents and calcineurin inhibitors, have been associated with adverse risk profiles. Consequently, alternative therapies have been developed. Rituximab is a promising addition to the therapeutic armamentarium of PMN. However, there are few head-to-head trials comparing rituximab with cyclophosphamide. In this clinical review, the results of the MENTOR, STARMEN, and RI-CYCLO trials are discussed and evaluated. Based on the results of these trials, a more personalized treatment approach is needed. World J Nephrol Urol. 2021;10(1):7-11 doi: https://doi.org/10.14740/wjnu426