在所有肾小球疾病中，膜性肾病（MN）可能是近几十年来在病因和治疗方面取得重大进展的疾病。尽管这些治疗方法（尤其是利妥昔单抗和基于皮质类固醇和环磷酰胺的周期疗法）的总体有效率较高，多年的经验表明20%～30%的病例可能面临抗药性疾病的困扰。因此，在治疗抗药性MN方面存在未满足的挑战，需要新的方法。目前正在评估几种新兴的抗原，在MN治疗方面主要用于治疗血液恶性肿瘤或风湿性疾病。本文进行了有关该疾病未来治疗策略的叙述性综述。在不同的新疗法中，新型抗CD20药物（比如奥比单抗），抗CD38药物（比如达坦单抗、费扎单抗），免疫吸附或抗补体疗法（比如伊普塔考帕单抗）引起了特别关注。此外，几种主要用于癌症治疗的技术和创新（比如嵌合抗原受体T细胞疗法、扫描抗体）似乎特别有前景。总之，MN的未来治疗前景令人鼓舞，并将无疑将该疾病的管理推向更加精准的方法。©作者2023年。由牛津大学出版社代表ERA出版。

Among all glomerular diseases, membranous nephropathy (MN) is perhaps the one in which major progress has been made in recent decades, in both the understanding of the pathogenesis and treatment. Despite the overall significant response rates to these therapies-particularly rituximab and cyclical regimen based on corticosteroids and cyclophosphamide-cumulative experience over the years has shown, however, that 20%-30% of cases may confront resistant disease. Thus, these unmet challenges in the treatment of resistant forms of MN require newer approaches. Several emerging new agents-developed primarily for the treatment of hematological malignancies or rheumatoid diseases-are currently being evaluated in MN. Herein we conducted a narrative review on future therapeutic strategies in the disease. Among the different novel therapies, newer anti-CD20 agents (e.g. obinutuzumab), anti-CD38 (e.g. daratumumab, felzartamab), immunoadsorption or anti-complement therapies (e.g. iptacopan) have gained special attention. In addition, several technologies and innovations developed primarily for cancer (e.g. chimeric antigen receptor T-cell therapy, sweeping antibodies) seem particularly promising. In summary, the future therapeutic landscape in MN seems encouraging and will definitely move the management of this disease towards a more precision-based approach.© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.