Effectiveness and safety of cyclophosphamide or tacrolimus therapy for idiopathic membranous nephropathy

Honghong Zou,Fang Jiang,Gaosi Xu

doi:10.1080/0886022x.2019.1637758

Abstract

Background: Guidelines recommend combined therapy of glucocorticoid and cyclophosphamide (CYC) for patients with idiopathic membranous nephropathy (IMN), while it is associated with severe adverse effects. We conducted a retrospective study to evaluate the effectiveness and safety of glucocorticoid plus tacrolimus (TAC) for IMN.Methods: Two hundred and three kidney-biopsy-proven IMN patients were enrolled in this study. One group (n = 142) received glucocorticoid combined with intravenous CYC (750 mg/m2 body surface) and the other group (n = 61) received glucocorticoid combined with oral TAC (target blood concentration of 4–8 ng/mL). The primary outcomes were achievement of remission and incidence of adverse events. The secondary end points included relapse rates, 24 h urinary protein (UP), serum albumin, serum creatinine and estimated glomerular filtration rate.Results: Over the 18-month observation period, the study suggested that the remission rates at the first 3 months were significantly higher in TAC group than in CYC group (72.1% versus 54.9%, p < .05). Although the cumulative incidence of serious and non-serious adverse events was not different significantly between the two groups, the incidence after first 3 months was lower in TAC group. 24hUP and serum albumin improved in TAC group more than the CYC group (p < .05) over the observed period.Conclusion: Because of its short-term effectiveness and long-term safety profile, glucocorticoid plus TAC might be a better option for IMN.

Highlights

Idiopathic membranous nephropathy (IMN) is one of the leading causes of nephrotic syndrome (NS) in adults [1]
All the revealed patients who were presenting to the Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Jiangxi Province, China would be screened out according to the enrollment and exclusion criteria
Secondary outcomes were as following: (1) Time to no response (NR) defined as a decrease in 24 h urinary protein (UP) less than 50% and/or 24 h UP > 3.5 g with a normal serum creatinine (Scr) concentration; (2) Time to relapses defined new NS after complete remission (CR) or partial remission (PR), without remission after two weeks; (3) The evolution of 24 h UP, serum albumin, estimated glomerular filtration rate (eGFR) and renal survival

Summary

Introduction

Idiopathic membranous nephropathy (IMN) is one of the leading causes of nephrotic syndrome (NS) in adults [1]. Current guidelines recommend glucocorticoid plus cyclophosphamide (CYC) as the initial therapy for patients with IMN [2]. This combined regimen has demonstrated a good effectiveness in remission, is associated with severe side effects [3,4]. A considerable number of IMN patients achieve spontaneous remission during the course of disease. According to these caveats, some physicians reluctantly implement the combined therapy of glucocorticoid and CYC to those patients with more unfavorable prognostic markers [5,6]. Guidelines recommend combined therapy of glucocorticoid and cyclophosphamide (CYC) for patients with idiopathic membranous nephropathy (IMN), while it is associated with severe adverse effects. Conclusion: Because of its short-term effectiveness and long-term safety profile, glucocorticoid plus TAC might be a better option for IMN

Methods

Results

Conclusion