Abstract
BackgroundIdiopathic membranous nephropathy (IMN) is one of the most common adult nephrotic syndromes. Some patients with this disorder require immunosuppressive therapy. This retrospective case series was performed to assess the effects of tacrolimus (TAC) combined with Tripterygium wilfordii polyglycoside (TWG) in treating IMN.MethodsFrom January 2015 to August 2016, kidney-biopsy-proven IMN patients treated with TAC in the Chinese PLA General Hospital were screened. Data were retrieved from the patients’ medical records. The first efficacy evaluation index was remission rate (complete remission and partial remission), and the secondary efficacy evaluation indices included relapse rate, proteinuria, serum albumin and estimated glomerular filtration rate (eGFR). Adverse events were also assessed.ResultsThe included patients’ treatments were tacrolimus monotherapy (TAC group, n = 33), tacrolimus combined with methylprednisolone (MP) (TAC + MP group, n = 24) and tacrolimus combined with Tripterygium wilfordii polyglycoside (TAC + TWG group, n = 21). The remission rates of the TAC, TAC + MP, and TAC + TWG groups in the 10th month were 54.5, 62.5, and 85.7%, respectively (TAC + TWG group vs TAC group, P = 0.037, TAC + TWG group vs TAC + MP group, P = 0.125). Moreover, the complete remission rates of the TAC, TAC + MP, and TAC + TWG groups in the 10th month were 21.2, 20.8, and 57.1%, respectively (TAC + TWG group vs TAC group, P = 0.007, TAC + TWG group vs TAC + MP group, P = 0.012). Compared with the TAC group, the TAC + TWG group had a higher remission rate during these ten months (log-rank, P = 0.005). Compared with the TAC and TAC + MP groups, the TAC + TWG group had a higher complete remission rate (log-rank, P = 0.019 and log-rank, P = 0.005, respectively).ConclusionThis retrospective study showed that TAC combined with TWG may be effective for treating IMN. Further randomized controlled trials (RCTs) are needed to assess the efficacy and safety of TAC combined with TWG.
Highlights
Idiopathic membranous nephropathy (IMN) is one of the most common adult nephrotic syndromes
Study population and oversight This study was a retrospective study conducted from January 1, 2015 to August 1, 2016, in which all biopsy-proven IMN cases treated with tacrolimus were screened at Chinese PLA General Hospital
Reasons for exclusion included being aged over 75 years (1 in the TAC group); lost to follow-up (1 in the TAC + Tripterygium wilfordii polyglycoside (TWG), 4 in the TAC, and 2 in the TAC + MP groups); not following the doctors’ prescriptions (2 in the TAC + TWG and 3 in the TAC + MP groups); and died in a traffic accident (2 in the TAC group)
Summary
Idiopathic membranous nephropathy (IMN) is one of the most common adult nephrotic syndromes Some patients with this disorder require immunosuppressive therapy. This retrospective case series was performed to assess the effects of tacrolimus (TAC) combined with Tripterygium wilfordii polyglycoside (TWG) in treating IMN. 34–62% of idiopathic membranous nephropathy (IMN) cases will progress to renal insufficiency [1] Immunosuppressive therapies, such as cyclosporine A, tacrolimus (TAC), and mycophenolate mofetil, have been shown to induce remission and. Liu S et al found that TWG combined with corticosteroid therapy was a more effective strategy for IMN [17]; it still produced corticosteroid-related side effects. We performed this retrospective study to investigate the effects of TAC combined with TWG on IMN, as these two drugs are based on different treatment mechanisms
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