Table 1.

Pros and cons of cyclophosphamide and rituximab in treating membranous nephropathy

CyclophosphamideIn use for several decades and familiar to most nephrologistsSignificant toxicity: myelotoxicity, infertility, and malignancy (cumulative dose dependent)
More readily available, particularly in developing countriesSteroid side effects: Cushing syndrome, uncontrolled diabetes, infections, poor wound healing, mood problems
Established efficacy in several randomized, controlled trialsNeed for frequent laboratory monitoring
May be more effective in patients with high PLA2R antibodies titerFixed regimen that cannot be tailored to the patient’s need
May achieve remission faster
RituximabEstablished efficacy in several randomized, controlled trialsMay achieve remission slower than cyclophosphamide
Intravenous dosing, which may improve adherenceRequires redosing
Favorable side effect profile and good tolerabilityInfusion-related reactions
Avoid exposure to high-dose steroidInsurance coverage
Can be tailored on the basis of antibody titers and allows for an individualized approach
Better option for patients of childbearing ages due to absence of reproductive toxicity
  • PLA2R, phospholipase A2 receptor.