SAT-373 PRIMARY MEMBRANOUS NEPHROPATHY MANAGEMENT WITH CALCINEURIN INHIBITORS AND ITS ASSOCIATED REMISSION AND LONG-TERM RELAPSE RATE: MEMBRANOUS G-COHORT STUDY

Abstract

Majority of the studies on primary membranous nephropathy (PMN) based the relapse rate associated with calcineurin inhibitors (CNI) on relatively short-term follow-up (<2years). We look to identify the efficacy of calcineurin inhibitors in inducing and maintaining remission over long term follow-up of 2years or more. Retrospective data was collected using the regional electronic database (eMED) on patients identified with PMN (n=31). Patients on initial immunosuppressive therapy with CNIs were included and data were assessed for remission induction, either complete remission (CR) or partial remission (PR) and subsequent relapses over a mean follow up period of 10±7 years from onset of diagnosis of PMN (n=16). CR was defined as urine protein to creatinine ratio (uPCR) <30mg/mmol and PR as >50% reduction from baseline in proteinuria and uPCR between 30 and 350 mg/mmol with stable eGFR. Relapse was defined as recurrence of uPCR > 350 mg/mmol after remission. Ciclosporin (CyA) with prednisolone was used in 14 patients (87.5%), Tacrolimus (Tac) monotherapy in 2 patients (12.5%). All patients achieved remission. PR occurred in 10 patients (62.5%) and complete remission in 6 patients (37.5%). Mean uPCR at the initiation of CNI was 783 ± 287 mg/mmol. At least one or more relapses were observed in 11 patients (68.8%) during the long term follow up. Mean duration of treatment was 3.6±2.2 years. Six patients (54.5%) relapsed while weaning off treatment while 5 patients (45.5%) off all treatment of which 3 patients were off treatment for more than 10 years.Tabled 1Patient CharacteristicsVariables ( n=16)Male11Female5Ethnicity - Irish - Non-IrishIrish : 11 Non Irish : 5Age at presentation in years41 ± 12eGFR at initiation of CNI ( ml/min/1.73m2)64 ± 14Urine Protein to Creatinine Ratio at initiation of CNI (mg/mmol)783 ± 287Gout6 (37.5%)Hypertension11 (68.8%)Ischaemic Heart Disease (IHD)4 (25%)Hyperlipidaemia6 (37.5%)Diabetes Mellitus3 (18.8%) Open table in a new tab Tabled 1Summary of results tableCiclosporin (CyA) with prednisolone, n (%)14 (87.5%)Tacrolimus (Tac) monotherapy, n (%)2 (12.5%)uPCR at initiation of CNI (mg/mmol)1783±287Follow up110±7 yearsDuration of treatment (years)13.6±2.2Partial remission, n (%)10 (62.5%)Complete remission, n (%)6 (37.5%)Relapse while weaning, n (%)6 (54.5%)Relapse while off treatment, n(%)5 (45.5%)Total relapse, n(%)11(68.8%)1-Mean± standard deviation, uPCR-Urine Protein to Creatinine ratio Open table in a new tab 1-Mean± standard deviation, uPCR-Urine Protein to Creatinine ratio CNIs are potent agents in remission induction in PMN. However, the relapse rate associated with CNIs in PMN is higher than previously documented when patients are followed for a prolonged duration. Majority of the patient's relapse when treatment is stopped or is being weaned off.