Pilot Trial of Hydroxychloroquine as Add-On Therapy in Patients With Membranous Nephropathy

Abstract

BackgroundKidney Disease Improving Global Outcomes guidelines indicate that glucocorticoids and immunosuppressants comprise the first therapeutic regimens after 4–6 months of treatment for high-risk primary membranous nephropathy (PMN). However, some patients cannot achieve complete or partial remission at 6 months. This study aimed to evaluate the efficacy of traditional immunotherapy combined with hydroxychloroquine (HCQ), a well-known immune regulator, in patients with PMN. MethodsThis was a single-center, open-label, prospective study. We recruited 72 patients with nephrotic syndrome and PMN proven by renal biopsy from May 2020 to June 2024. We compared changes in proteinuria, serum albumin levels, estimated glomerular filtration rate, and relapse rate at 3, 6, 9, and 12 months follow up in 41 patients who received glucocorticoid and immunosuppressant, and in 31 who received HCQ plus standard-of-care. ResultsBaseline characteristics showed no statistical significance between the two groups. However, the HCQ group showed significantly reduced proteinuria compared to standard-of-care group. A reduced proteinuria was seen at 6 months [1.2 (0.4, 2.2) vs. 2.2 (1.0, 3.8) g/day, P = 0.029] and the relapse rate with 12 months follow up was also significantly decreased in HCQ group compared to standard-of-care group (3.7% vs. 23.3%, P = 0.033). ConclusionsHCQ may serve as an effective add-on therapy for primary membranous nephropathy.