#5-69E. Redefining Remission: Obinutuzumab Superiority in Primary Membranous Nephropathy (NEJM, 2026)

How can clinicians achieve durable remission in primary membranous nephropathy without relying solely on chronic calcineurin inhibition? The randomized phase 3 MAJESTY trial revealed that obinutuzumab was markedly superior to tacrolimus, delivering a 104-week complete remission rate of 37% versus 6%. Although its open-label design and two-year follow-up mandate caution regarding long-term renal protection, these findings establish obinutuzumab as a transformative therapy that could reshape clinical algorithms for achieving deep immunologic control.

Citation: Fervenza FC, Hou FF, Hao CM, Kirsztajn GM, Gesualdo L, Hryszko T, et al. Obinutuzumab or Tacrolimus in Primary Membranous Nephropathy. N Engl J Med. 2026. DOI: 10.1056/NEJMoa2602678

URL: https://doi.org/10.1056/NEJMoa2602678

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