Obinutuzumab alone may be an effective option for adult minimal change disease: a single-center retrospective observational study

BACKGROUND: Obinutuzumab is a novel glycoengineered type II anti-CD20 monoclonal antibody with more potent and sustained B-cell depletion than rituximab. This study aimed to evaluate the efficacy and safety of obinutuzumab monotherapy in adult patients with minimal change disease (MCD). METHODS: We conducted a retrospective study including adult MCD patients treated with obinutuzumab or glucocorticoids (GC) between January 1, 2020 and June 30, 2025. The primary outcome was complete remission (CR) of nephrotic syndrome. Secondary outcomes included relapse and adverse events. RESULTS: 38 patients were enrolled (16 in the obinutuzumab group, 22 in the GC group). 9 patients in the obinutuzumab group had steroid-dependent or steroid-resistant MCD, and 7 were new-onset MCD treated with obinutuzumab due to GC intolerance, contraindications, or comorbidities. In new-onset MCD, patients receiving obinutuzumab were older with higher prevalence of hypertension, BMI, and HbA1c. The CR rate was 68.8% (11/16) in the obinutuzumab group, with no significant differences in CR rate or time to remission compared with GC. Multivariate Cox regression showed that obinutuzumab treatment was not independently associated with CR. No relapses were observed in the obinutuzumab group during follow-up, whereas 27.3% of GC-treated patients relapsed. CONCLUSION: This single-center retrospective study provides preliminary evidence that obinutuzumab monotherapy may induce and maintain remission in selected adult MCD patients (e.g., those with GC contraindications or intolerance). While its remission rate is comparable to conventional GC therapy in our cohort, further prospective validation is required before it can be recommended as a routine alternative to GC.