Two-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and Cyclophosphamide
Both cCTX/GCs and CNIs are recommended as first-line agents in the management of PMN. The present study is an extended report of patients randomized to receive TAC/GCs or cCTX/GCs at 2 years post randomization. Methods: Seventy patients enrolled in the clinical trial Tacrolimus Combined With Cortico...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-07-01
|
| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024917300219 |
| _version_ | 1818117293023952896 |
|---|---|
| author | Raja Ramachandran Ashok Kumar Yadav Vinod Kumar Venkata Siva Tez Pinnamaneni Ritambhra Nada Ratan Ghosh Vivek Kumar Manish Rathi Harbir Singh Kohli Krishan Lal Gupta Vinay Sakhuja Vivekanand Jha |
| author_facet | Raja Ramachandran Ashok Kumar Yadav Vinod Kumar Venkata Siva Tez Pinnamaneni Ritambhra Nada Ratan Ghosh Vivek Kumar Manish Rathi Harbir Singh Kohli Krishan Lal Gupta Vinay Sakhuja Vivekanand Jha |
| author_sort | Raja Ramachandran |
| collection | DOAJ |
| description | Both cCTX/GCs and CNIs are recommended as first-line agents in the management of PMN. The present study is an extended report of patients randomized to receive TAC/GCs or cCTX/GCs at 2 years post randomization.
Methods: Seventy patients enrolled in the clinical trial Tacrolimus Combined With Corticosteroids Versus Modified Ponticelli Regimen in Treatment of Idiopathic Membranous Nephropathy: Randomized Control Trial were followed quarterly between 12 and 24 months. At the end of 24 months, 3 patients were lost to follow-up.
Results: At 18 months, 66% and 89% (P = 0.04) were in remission in TAC/GCs and cCTX/GCs groups, respectively. At 18 and 24 months, 60% and 86% (P = 0.03) of cases were in remission in the TAC/GCs and cCTX/GCs groups, respectively. At 18 months, 57% and 83% (P = 0.03) of the patients in TAC/GCs and cCTX/GCs groups were in remission without need of any additional immunosuppression (persistent remission) and, at 24 months, 43% and 80% (P = 0.002) were in persistent remission in TAC/GCs and cCTX/GCs groups, respectively. Relapse rate after any remission was 40% and 6.7% in TAC/GCs and cCTX/GCs groups, respectively (P = 0.007). There was an association of aPLA2R titers with remission or resistance (P = 0.006) in relapsing PMN. The significant decrease in eGFR after 12 months of TAC/GCs therapy normalized at 18 and 24 months.
Discussion: At 2 years after randomization, relapse rates are higher for TAC/GCs compared with cCTX/GCs in PMN patients. Thus, cCTX/GCs are better than TAC/GCs in the longer term in PMN patients. |
| first_indexed | 2024-12-11T04:36:06Z |
| format | Article |
| id | doaj.art-4715a02edb324416a3398926f8d71704 |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-11T04:36:06Z |
| publishDate | 2017-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-4715a02edb324416a3398926f8d717042022-12-22T01:20:43ZengElsevierKidney International Reports2468-02492017-07-012461061610.1016/j.ekir.2017.02.004Two-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and CyclophosphamideRaja Ramachandran0Ashok Kumar Yadav1Vinod Kumar2Venkata Siva Tez Pinnamaneni3Ritambhra Nada4Ratan Ghosh5Vivek Kumar6Manish Rathi7Harbir Singh Kohli8Krishan Lal Gupta9Vinay Sakhuja10Vivekanand Jha11Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Nephrology, Oxford University, Oxford, UKBoth cCTX/GCs and CNIs are recommended as first-line agents in the management of PMN. The present study is an extended report of patients randomized to receive TAC/GCs or cCTX/GCs at 2 years post randomization. Methods: Seventy patients enrolled in the clinical trial Tacrolimus Combined With Corticosteroids Versus Modified Ponticelli Regimen in Treatment of Idiopathic Membranous Nephropathy: Randomized Control Trial were followed quarterly between 12 and 24 months. At the end of 24 months, 3 patients were lost to follow-up. Results: At 18 months, 66% and 89% (P = 0.04) were in remission in TAC/GCs and cCTX/GCs groups, respectively. At 18 and 24 months, 60% and 86% (P = 0.03) of cases were in remission in the TAC/GCs and cCTX/GCs groups, respectively. At 18 months, 57% and 83% (P = 0.03) of the patients in TAC/GCs and cCTX/GCs groups were in remission without need of any additional immunosuppression (persistent remission) and, at 24 months, 43% and 80% (P = 0.002) were in persistent remission in TAC/GCs and cCTX/GCs groups, respectively. Relapse rate after any remission was 40% and 6.7% in TAC/GCs and cCTX/GCs groups, respectively (P = 0.007). There was an association of aPLA2R titers with remission or resistance (P = 0.006) in relapsing PMN. The significant decrease in eGFR after 12 months of TAC/GCs therapy normalized at 18 and 24 months. Discussion: At 2 years after randomization, relapse rates are higher for TAC/GCs compared with cCTX/GCs in PMN patients. Thus, cCTX/GCs are better than TAC/GCs in the longer term in PMN patients.http://www.sciencedirect.com/science/article/pii/S2468024917300219cyclophosphamidemembranous nephropathyPLA2Rrandomized control trialsteroidstacrolimus |
| spellingShingle | Raja Ramachandran Ashok Kumar Yadav Vinod Kumar Venkata Siva Tez Pinnamaneni Ritambhra Nada Ratan Ghosh Vivek Kumar Manish Rathi Harbir Singh Kohli Krishan Lal Gupta Vinay Sakhuja Vivekanand Jha Two-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and Cyclophosphamide Kidney International Reports cyclophosphamide membranous nephropathy PLA2R randomized control trial steroids tacrolimus |
| title | Two-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and Cyclophosphamide |
| title_full | Two-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and Cyclophosphamide |
| title_fullStr | Two-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and Cyclophosphamide |
| title_full_unstemmed | Two-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and Cyclophosphamide |
| title_short | Two-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and Cyclophosphamide |
| title_sort | two year follow up study of membranous nephropathy treated with tacrolimus and corticosteroids versus cyclical corticosteroids and cyclophosphamide |
| topic | cyclophosphamide membranous nephropathy PLA2R randomized control trial steroids tacrolimus |
| url | http://www.sciencedirect.com/science/article/pii/S2468024917300219 |
| work_keys_str_mv | AT rajaramachandran twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT ashokkumaryadav twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT vinodkumar twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT venkatasivatezpinnamaneni twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT ritambhranada twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT ratanghosh twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT vivekkumar twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT manishrathi twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT harbirsinghkohli twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT krishanlalgupta twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT vinaysakhuja twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide AT vivekanandjha twoyearfollowupstudyofmembranousnephropathytreatedwithtacrolimusandcorticosteroidsversuscyclicalcorticosteroidsandcyclophosphamide |