Abstract：
BACKGROUND: Although rituximab (RTX) is recommended by kidney disease improving global outcomes as one of the standard therapies for primary membranous nephropathy (pMN), given the constraint of insurance coverage, it is not clear how the drug is used in Japan.
METHODS: This cross-sectional study was conducted via a web-based survey between November and December 2021. The participants were certified nephrologists and recruited through convenience sampling. Experience with RTX for pMN was compared to experience with RTX for minimal change nephrotic syndrome (MCNS). Reasons for withholding RTX for pMN, even when it is indicated, were also investigated. Furthermore, the proportion difference in RTX experience was analyzed.
RESULTS: Responses from 380 nephrologists across 278 facilities were analyzed. RTX was used for pMN by 83 (21.8%), which was less than the 181 (47.6%) who had used RTX for MCNS (ratio of proportions: 0.46). RTX use for pMN was more frequent in facilities performing 41-80 and 81 or more kidney biopsies annually (vs. none) and by physicians with experience in anti-PLA2R antibody measurement. RTX administration for pMN was covered by insurance for 56 (67.5%), was facility-paid for 10 (12.0%), and was copaid by patients for 6 (7.2%). The most common reason for withholding RTX for pMN was difficulty in ensuring financing (146, 79.3%).
CONCLUSIONS: RTX use for pMN is less common than for MCNS but not infrequent. Treatment with RTX was more frequent in biopsy-intensive facilities, and it was fully paid by the facility or patient in one-fifth of cases.
METHODS: This cross-sectional study was conducted via a web-based survey between November and December 2021. The participants were certified nephrologists and recruited through convenience sampling. Experience with RTX for pMN was compared to experience with RTX for minimal change nephrotic syndrome (MCNS). Reasons for withholding RTX for pMN, even when it is indicated, were also investigated. Furthermore, the proportion difference in RTX experience was analyzed.
RESULTS: Responses from 380 nephrologists across 278 facilities were analyzed. RTX was used for pMN by 83 (21.8%), which was less than the 181 (47.6%) who had used RTX for MCNS (ratio of proportions: 0.46). RTX use for pMN was more frequent in facilities performing 41-80 and 81 or more kidney biopsies annually (vs. none) and by physicians with experience in anti-PLA2R antibody measurement. RTX administration for pMN was covered by insurance for 56 (67.5%), was facility-paid for 10 (12.0%), and was copaid by patients for 6 (7.2%). The most common reason for withholding RTX for pMN was difficulty in ensuring financing (146, 79.3%).
CONCLUSIONS: RTX use for pMN is less common than for MCNS but not infrequent. Treatment with RTX was more frequent in biopsy-intensive facilities, and it was fully paid by the facility or patient in one-fifth of cases.
摘要：
背景：尽管肾脏疾病推荐利妥昔单抗（RTX）作为原发性膜性肾病（pMN）的标准疗法之一，改善全球预后，考虑到保险范围的限制，目前还不清楚这种药物在日本是如何使用的。
方法：这项横断面研究是在2021年11月至12月之间通过基于网络的调查进行的。参与者是经过认证的肾脏病学家，并通过便利抽样招募。将RTX用于pMN的经验与RTX用于微小变化性肾病综合征（MCNS）的经验进行比较。为pMN扣留RTX的原因，即使它被指示，也被调查了。此外，分析了RTX经验的比例差异。
结果：分析了来自278家机构的380名肾病学家的反应。83例(21.8%)将RTX用于pMN，低于使用RTX进行MCNS的181人（47.6％）（比例：0.46）。在每年进行41-80和81或更多肾脏活检的设施中，RTX用于pMN的频率更高（与无）和具有抗PLA2R抗体测量经验的医生。PMN的RTX管理由56人(67.5%)的保险承保，是支付10英镑(12.0%)的设施费用，并由6例患者共同支付（7.2％）。为pMN扣留RTX的最常见原因是难以确保融资(146，79.3%)。
结论：RTX用于pMN比用于MCNS更不常见，但并非罕见。在活检密集设施中，RTX治疗更为频繁，在五分之一的病例中，它由设施或患者全额支付。
方法：这项横断面研究是在2021年11月至12月之间通过基于网络的调查进行的。参与者是经过认证的肾脏病学家，并通过便利抽样招募。将RTX用于pMN的经验与RTX用于微小变化性肾病综合征（MCNS）的经验进行比较。为pMN扣留RTX的原因，即使它被指示，也被调查了。此外，分析了RTX经验的比例差异。
结果：分析了来自278家机构的380名肾病学家的反应。83例(21.8%)将RTX用于pMN，低于使用RTX进行MCNS的181人（47.6％）（比例：0.46）。在每年进行41-80和81或更多肾脏活检的设施中，RTX用于pMN的频率更高（与无）和具有抗PLA2R抗体测量经验的医生。PMN的RTX管理由56人(67.5%)的保险承保，是支付10英镑(12.0%)的设施费用，并由6例患者共同支付（7.2％）。为pMN扣留RTX的最常见原因是难以确保融资(146，79.3%)。
结论：RTX用于pMN比用于MCNS更不常见，但并非罕见。在活检密集设施中，RTX治疗更为频繁，在五分之一的病例中，它由设施或患者全额支付。
