Primary membranous nephropathy (PMN) is a leading cause of nephrotic syndrome in adults, often progressing to end-stage renal disease (ESRD). While glucocorticoids (GCs) combined with immunosuppressants are commonly used, their comparative efficacy and safety remain unclear. This network meta-analysis aimed to evaluate the efficacy and safety of various GC-immunosuppressant combinations in PMN treatment, conducted following PRISMA guidelines. Databases including PubMed, Embase, and Web of Science were searched up to September 2024. Primary outcomes were 24-hour urinary protein (24hUTP), serum creatinine (SCr), remission rates (CR, PR, TR), relapse, and infection rates. Effect sizes were expressed as standardized mean differences (SMD) and odds ratios (OR) with 95% credible intervals (CrIs). Twenty-four RCTs involving 1403 PMN patients were included. The combination of GCs+rituximab (GCs+RTX) significantly reduced 24hUTP (SMD = -1.17; 95% CrI: -2.32 to -0.03) and ranked highest in reducing SCr (SMD = -1.63; 95% CrI: -3.15 to -0.11). GCs+cyclophosphamide (GCs+CYC) showed the highest remission rates (CR: OR = 3.48; 95% CrI: 1.19 to 10.20) and consistently reduced relapse. GCs+cyclosporine (GCs+CsA) had the lowest infection risk (OR = 0.69; 95% CrI: 0.48 to 1.02). GCs+RTX demonstrated superior efficacy in reducing proteinuria and preserving renal function, while GCs+CYC was most effective in achieving remission and preventing relapse. GCs+CsA had the best safety profile with regard to infection risk. These findings suggest that treatment decisions should consider both efficacy and safety profiles to optimize outcomes for PMN patients.