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MAJESTY: Obinutuzumab can offer remission in membranous nephropathy

Compared to tacrolimus, obinutuzumab improved rates of complete and partial remission in patients with primary membranous nephropathy, while demonstrating comparable infection rates between the 2 treatment regimens.

Prof. Fernando Custodio Fervenza (Mayo Clinic, MN, USA) presented results from MAJESTY (NCT04629248), a phase 3, randomised, open-label, multicentre study comparing obinutuzumab with tacrolimus [1]. Patients were eligible if they had biopsy-confirmed membranous nephropathy, a 24-hour urine protein-to-creatinine ratio (UPCR) ≥5 g/g for 3 months or ≥4 g/g for 6 months despite receiving the best available therapy, and an estimated glomerular filtration rate (eGFR) ≥40 mL/min/1.73 m2. Patients were randomised 1:1 to receive obinutuzumab 1 g infusions at weeks 0, 2, 24, and 26, or to tacrolimus through week 60. The primary endpoint was complete remission at week 104, defined as UPCR  ≤0.3 g/g with stable eGFR (no more than a 15% decline from baseline). A total of 142 patients were randomised.

The MAJESTY trial met its primary endpoint, with more patients receiving obinutuzumab than tacrolimus achieving complete remission at week 104. Furthermore, a greater proportion of patients receiving obinutuzumab achieved a proteinuric response at week 104. Obinutuzumab also resulted in higher rates of overall remission (complete or partial) at week 104 (51% vs 13%) and of complete remission at week 76 (36% vs 9%) compared with tacrolimus. Infections occurred in 61% of patients receiving obinutuzumab and 57% of those receiving tacrolimus, while serious infections occurred in 6% of patients in each group. Infusion-related reactions were reported in 38% of patients receiving obinutuzumab.

“In conclusion, obinutuzumab demonstrated superiority over tacrolimus in achieving complete remission at week 104,” concluded Prof. Fervenza. “Obinutuzumab also improved overall remission at week 104 and complete response at week 76, and no new safety signals were identified.”

  1. Fervenza FC, et al. Efficacy and safety of obinutuzumab compared with tacrolimus in primary membranous nephropathy: Topline results of the phase III MAJESTY trial. ERA 2026, 3–6 June. Glasgow, Scotland.

 Copyright ©2026 Medicom Education B.V.

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Rituximab effectively prolongs steroid-induced remission of nephrotic syndrome: TURING

Compared with placebo, rituximab prolonged remission by more than 2 years in patients with nephrotic syndrome due to minimal change disease or focal segmental glomerulosclerosis who responded to steroid treatment, according to clinical trial data reported by Dr Lisa Willcocks (Cambridge University Hospital, UK) and Prof. Megan Griffith (Imperial College London, UK) [1].

The TURING trial (EudraCT 2018-004611-50) was a phase 3, randomised, placebo-controlled trial evaluating rituximab in patients with nephrotic syndrome secondary to minimal change disease and focal segmental glomerulosclerosis. Patients were eligible if they had de novo or relapsing disease. At study entry, all patients received high-dose prednisolone until remission or for up to 16 weeks. Simultaneously, patients were randomised to receive either rituximab (1 g administered at weeks 0, 2, and 26) or matching placebo. Patients who did not achieve remission with prednisolone by week 16 were excluded from the primary analysis. The primary endpoint was the time from remission to relapse. Of the 149 patients enrolled, 122 achieved remission by week 16 and were included in the analysis.

Overall, 45 of 59 patients in the placebo group and 22 of 63 patients in the rituximab group relapsed. The median time to relapse was 22 weeks in the placebo group and was not reached in the rituximab group, corresponding to an HR of 0.22 in favour of rituximab (95% CI 0.13–0.37; P<0.0001). Subgroup analyses showed consistent results across groups defined by disease presentation (de novo vs relapsing disease), disease type (minimal change disease vs focal segmental glomerulosclerosis), prednisolone regimen, sex, ethnicity, and age at first presentation with nephrotic syndrome. Adverse events reported more frequently with rituximab included infusion-related reactions, infections, and hypogammaglobulinaemia.

“Three 1 g doses of rituximab can maintain remission for more than 2.8 years,” concluded Prof. Griffith. She added that “patients were exposed to high-doses of steroids during the trial, and we as a community need additional strategies to reduce glucocorticoid exposure in our patients.”

  1. Willcocks L, et al. The Use of Rituximab In the treatment of Nephrotic Glomerulonephritis (TURING): a multicentre, double-blind, randomised, placebo-controlled trial. ERA 2026, 3–6 June. Glasgow, Scotland.

 Copyright ©2026 Medicom Education B.V.

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FLOW: Semaglutide improves quality of life in type 2 diabetes

Compared with placebo, semaglutide significantly improved multiple quality-of-life measures in patients with type 2 diabetes and chronic kidney disease (CKD), according to data presented by Prof. Johannes Mann (Friedrich-Alexander University, Germany) [1].

FLOW (NCT03819153) was a phase 3, randomised, placebo-controlled trial that assigned patients with type 2 diabetes and concomitant CKD to once-weekly semaglutide plus standard of care or matching placebo plus standard of care. Patients were eligible if they had glycated haemoglobin (HbA1c) ≤10% and were receiving a renin–angiotensin–aldosterone system (RAAS) blocker. The primary endpoint, time to first occurrence of a kidney event, was met and had been previously reported. Patient-reported outcomes, assessed using the EuroQol-5-Dimensions, 5-Levels (EQ-5D-5L) questionnaire, were prespecified exploratory endpoints and were collected at baseline and annually throughout the trial.

After 104 weeks, semaglutide significantly improved scores compared with placebo in the mobility, self-care, usual activities, and pain/discomfort subdomains of the EQ-5D-5L questionnaire, but not in the anxiety/depression domain (p=0.55). Furthermore, the EQ-5D-5L visual analogue scale (VAS) score increased by 1.05 points with semaglutide and decreased by 1.10 points with placebo, corresponding to a between-group difference of 2.15 points (95% CI 1.15–3.15), indicating an improvement in overall quality of life. However, analysis of the EQ-5D-5L utility score showed no difference between treatment groups after 104 weeks.

“In adults with type 2 diabetes and CKD, semaglutide treatment, despite its known gastrointestinal effects, was associated with higher quality-of-life scores, corresponding to an estimated additional 8 days of full health per year,” concluded Prof. Mann. “The improvements in quality of life were observed across multiple domains, including mobility, self-care, usual activities and pain/discomfort.”

  1. Mann J, et al. The effects of semaglutide on health-related quality of life in adults with type 2 diabetes and chronic kidney disease: FLOW trial. ERA 2026, 3–6 June. Glasgow, Scotland.

 Copyright ©2026 Medicom Education B.V.

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