Efficacy and safety of high-dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathy
Objective To evaluate the efficacy and safety of high-dose cyclophosphamide (CTX) intravenous injection combined with glucocorticoid in the treatment of idiopathic membranous nephropathy (IMN). Methods Clinical data of 78 IMN patients with manifestation of nephrotic syndrome (NS) admitted in Guangdo...
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Editorial Office of Journal of Third Military Medical University
2021-06-01
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| Series: | Di-san junyi daxue xuebao |
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| Online Access: | http://aammt.tmmu.edu.cn/Upload/rhtml/202012213.htm |
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| author | XIE Xinfu XIE Xinfu XIE Bingying XIE Bingying ZHENG Quan ZHENG Quan |
| author_facet | XIE Xinfu XIE Xinfu XIE Bingying XIE Bingying ZHENG Quan ZHENG Quan |
| author_sort | XIE Xinfu |
| collection | DOAJ |
| description | Objective To evaluate the efficacy and safety of high-dose cyclophosphamide (CTX) intravenous injection combined with glucocorticoid in the treatment of idiopathic membranous nephropathy (IMN). Methods Clinical data of 78 IMN patients with manifestation of nephrotic syndrome (NS) admitted in Guangdong Provincial People's Hospital from January 2007 to June 2019 were collected and retrospectively analyzed. The patients were assigned into either intravenous CTX combined with glucocorticoid group (ICTX group, n=39), or oral CTX combined with glucocorticoid group (OCTX group, n=39). The subjects of ICTX group were treated with monthly intravenous CTX administration 0.50~0.75 g/m2+oral prednisone 0.5 mg/(kg·d) for 6 months. By contrast, those in OCTX group were given intravenous methylprednisolone 0.5 g qd×3 d+oral prednisone 0.5 mg/(kg·d)×27 d in the first, third and fifth month, respectively, and given oral CTX 2.5mg/(kg·d)+ oral prednisone 10 mg/d in the second, fourth and sixth month, respectively. Comparison was made between the 2 groups about the remission of proteinuria, serum albumin (sALB), estimated glomerular filtration rate (eGFR), recurrence rate and incidence of adverse reactions (ADR) before and 3, 6 and 12 months after the treatment. Results The total remission rate of proteinuria in ICTX group was higher than that in OCTX group at 3, 6, 12 months (50.0% vs 46.4%; 59.4% vs 50.0%; 88.9% vs 75.0%, respectively), though showed no significant differences. sALB and eGFR in both groups were significantly increased from baseline, while 24 h urinary protein (24hUP) and serum creatinine (Scr) were decreased in 3, 6, 12 months after the treatment (P < 0.05); and sALB had a more significant rise in ICTX group than OCTX group at 3 months (6.2 vs 4.8 g/L, P=0.013). After complete remission (CR) or partial remission (PR), the recurrence rates of ICTX and OCTX groups represented 8.3% and 13.0%, respectively, with no significant differences. In addition, the WBC count in the ICTX group was higher than that in the OCTX group at 3 months. Finally, a total of 9 cases of ADR occurred in the ICTX group (23.1%) and 10 cases in the OCTX group (25.6%). Conclusion The ICTX regimen significantly reduces proteinuria of IMN patients with clinical manifestation of NS, improving the remission rate of proteinuria, increasing serum albumin rapidly, and showing a low recurrence rate, good tolerance, as well as no significant increase in adverse reactions. |
| first_indexed | 2024-12-16T18:09:34Z |
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| id | doaj.art-54b0743e1a1047feacb1e6df01214bb4 |
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| publishDate | 2021-06-01 |
| publisher | Editorial Office of Journal of Third Military Medical University |
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| series | Di-san junyi daxue xuebao |
| spelling | doaj.art-54b0743e1a1047feacb1e6df01214bb42022-12-21T22:21:49ZzhoEditorial Office of Journal of Third Military Medical UniversityDi-san junyi daxue xuebao1000-54042021-06-0143121173117810.16016/j.1000-5404.202012213Efficacy and safety of high-dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathyXIE Xinfu0XIE Xinfu1XIE Bingying2XIE Bingying3ZHENG Quan4ZHENG Quan5Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, 510515Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong Province, 510000 Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong Province, 510000 Medical College of Shantou University, Shantou, Guangdong Province, 515000, ChinaDepartment of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong Province, 510000Medical College of Shantou University, Shantou, Guangdong Province, 515000, ChinaObjective To evaluate the efficacy and safety of high-dose cyclophosphamide (CTX) intravenous injection combined with glucocorticoid in the treatment of idiopathic membranous nephropathy (IMN). Methods Clinical data of 78 IMN patients with manifestation of nephrotic syndrome (NS) admitted in Guangdong Provincial People's Hospital from January 2007 to June 2019 were collected and retrospectively analyzed. The patients were assigned into either intravenous CTX combined with glucocorticoid group (ICTX group, n=39), or oral CTX combined with glucocorticoid group (OCTX group, n=39). The subjects of ICTX group were treated with monthly intravenous CTX administration 0.50~0.75 g/m2+oral prednisone 0.5 mg/(kg·d) for 6 months. By contrast, those in OCTX group were given intravenous methylprednisolone 0.5 g qd×3 d+oral prednisone 0.5 mg/(kg·d)×27 d in the first, third and fifth month, respectively, and given oral CTX 2.5mg/(kg·d)+ oral prednisone 10 mg/d in the second, fourth and sixth month, respectively. Comparison was made between the 2 groups about the remission of proteinuria, serum albumin (sALB), estimated glomerular filtration rate (eGFR), recurrence rate and incidence of adverse reactions (ADR) before and 3, 6 and 12 months after the treatment. Results The total remission rate of proteinuria in ICTX group was higher than that in OCTX group at 3, 6, 12 months (50.0% vs 46.4%; 59.4% vs 50.0%; 88.9% vs 75.0%, respectively), though showed no significant differences. sALB and eGFR in both groups were significantly increased from baseline, while 24 h urinary protein (24hUP) and serum creatinine (Scr) were decreased in 3, 6, 12 months after the treatment (P < 0.05); and sALB had a more significant rise in ICTX group than OCTX group at 3 months (6.2 vs 4.8 g/L, P=0.013). After complete remission (CR) or partial remission (PR), the recurrence rates of ICTX and OCTX groups represented 8.3% and 13.0%, respectively, with no significant differences. In addition, the WBC count in the ICTX group was higher than that in the OCTX group at 3 months. Finally, a total of 9 cases of ADR occurred in the ICTX group (23.1%) and 10 cases in the OCTX group (25.6%). Conclusion The ICTX regimen significantly reduces proteinuria of IMN patients with clinical manifestation of NS, improving the remission rate of proteinuria, increasing serum albumin rapidly, and showing a low recurrence rate, good tolerance, as well as no significant increase in adverse reactions.http://aammt.tmmu.edu.cn/Upload/rhtml/202012213.htmcyclophosphamideglucocorticoidsidiopathic membranous nephropathynephrotic syndromeremission rate |
| spellingShingle | XIE Xinfu XIE Xinfu XIE Bingying XIE Bingying ZHENG Quan ZHENG Quan Efficacy and safety of high-dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathy Di-san junyi daxue xuebao cyclophosphamide glucocorticoids idiopathic membranous nephropathy nephrotic syndrome remission rate |
| title | Efficacy and safety of high-dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathy |
| title_full | Efficacy and safety of high-dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathy |
| title_fullStr | Efficacy and safety of high-dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathy |
| title_full_unstemmed | Efficacy and safety of high-dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathy |
| title_short | Efficacy and safety of high-dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathy |
| title_sort | efficacy and safety of high dose cyclophosphamide intravenous boost combined with glucocorticoid in treatment of idiopathic membranous nephropathy |
| topic | cyclophosphamide glucocorticoids idiopathic membranous nephropathy nephrotic syndrome remission rate |
| url | http://aammt.tmmu.edu.cn/Upload/rhtml/202012213.htm |
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