{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T05:27:28Z","timestamp":1766467648738,"version":"3.37.3"},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T00:00:00Z","timestamp":1681171200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,31]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Primary membranous nephropathy (MN) is the most frequent cause of nephrotic syndrome in adults, due to a variety of autoantibodies, most frequently against phospholipase A2 receptor (PLA2R). In severe cases or when spontaneous remission is not achieved, immunosuppression is required. Cyclical therapy, based on glucocorticoids and cyclophosphamide on alternate months for 6\u00a0months, has proven effective to induce remission and reduce the risk of end-stage renal disease. Since the early 2000s, rituximab (RTX) has emerged as a key player in the management of MN, showing overall comparable effectiveness and likely better safety compared with the cyclical regimen, despite the lack of adequately powered trials comparing the two approaches head to head. For these reasons, RTX is now considered the agent of choice for most patients with MN. However, there are still uncertainties. Around 20\u201340% of patients are resistant to RTX, especially in the setting of high anti-PLA2R levels, and this drug remains relatively unexplored in patients with the most severe disease. In these scenarios, although the expanding therapeutic armamentarium is probably going to provide further options, the cyclical regimen still plays a key role as a safety net. The aim of this article is to illustrate the role of cyclical therapy in the RTX era.<\/jats:p>","DOI":"10.1093\/ckj\/sfad081","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T02:01:25Z","timestamp":1681178485000},"page":"1426-1431","source":"Crossref","is-referenced-by-count":5,"title":["The place of cyclical therapy for the treatment of membranous nephropathy in the era of rituximab"],"prefix":"10.1093","volume":"16","author":[{"given":"Federico","family":"Alberici","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia , Brescia , Italy"},{"name":"Nephrology Unit, Spedali Civili di Brescia Hospital, ASST Spedali Civili di Brescia , Brescia , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2759-4027","authenticated-orcid":false,"given":"Federica","family":"Mescia","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia , Brescia , Italy"},{"name":"Nephrology Unit, Spedali Civili di Brescia Hospital, ASST Spedali Civili di Brescia , Brescia , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Scolari","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia , Brescia , Italy"},{"name":"Nephrology Unit, Spedali Civili di Brescia Hospital, ASST Spedali Civili di Brescia , Brescia , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,4,10]]},"reference":[{"key":"2023083104271800900_bib1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41572-021-00303-z","article-title":"Membranous nephropathy","volume":"7","author":"Ronco","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"2023083104271800900_bib2","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1681\/ASN.2009080861","article-title":"Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy","volume":"21","author":"Polanco","year":"2010","journal-title":"J Am Soc Nephrol"},{"key":"2023083104271800900_bib3","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1038\/ki.1974.129","article-title":"Controlled trial of cyclophosphamide in idiopathic membranous nephropathy","volume":"6","author":"Donadio","year":"1974","journal-title":"Kidney Int"},{"key":"2023083104271800900_bib4","first-page":"1301","article-title":"A controlled study of short-term prednisone treatment in adults with membranous nephropathy\u2014collaborative study of the adult idiopathic nephrotic syndrome","volume-title":"N Engl J Med","year":"1979"},{"key":"2023083104271800900_bib5","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1056\/NEJM198901263200403","article-title":"A randomized controlled trial of prednisone in patients with idiopathic membranous nephropathy","volume":"320","author":"Cattran","year":"1989","journal-title":"N Engl J Med"},{"key":"2023083104271800900_bib6","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1093\/oxfordjournals.qjmed.a068422","article-title":"The Medical Research Council trial of short-term high-dose alternate day prednisolone in idiopathic membranous nephropathy with nephrotic syndrome in adults","volume":"74","author":"Cameron","year":"1990","journal-title":"Q J Med"},{"key":"2023083104271800900_bib7","first-page":"655","article-title":"Treatment with chlorambucil and azathioprine in primary glomerulonephritis. 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