Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy
Immunosuppressive therapy plays an important role in patients with high-risk idiopathic membranous nephropathy (IMN), but the therapeutic modality is still controversial. Methods: Corticosteroid combined with oral tacrolimus (TAC, target trough blood concentration of 4–8 ng/mL), intravenous cyclopho...
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| Format: | Article |
| Language: | English |
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Elsevier
2016-01-01
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| Series: | Journal of the Formosan Medical Association |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664615002776 |
| _version_ | 1818410472170323968 |
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| author | Lei Peng Shi-Yao Wei Lei-Ting Li Yi-Xin He Bing Li |
| author_facet | Lei Peng Shi-Yao Wei Lei-Ting Li Yi-Xin He Bing Li |
| author_sort | Lei Peng |
| collection | DOAJ |
| description | Immunosuppressive therapy plays an important role in patients with high-risk idiopathic membranous nephropathy (IMN), but the therapeutic modality is still controversial.
Methods: Corticosteroid combined with oral tacrolimus (TAC, target trough blood concentration of 4–8 ng/mL), intravenous cyclophosphamide (CYC, 750 mg/m2/mo, or oral mycophenolate mofetil (MMF, 1.5–2.0 g/d) were randomly administered for 9 months to 90 patients with IMN proved with renal biopsy with severe proteinuria (>8 g/d).
Results: Eighty-six of the 90 patients completed the study. The total remission (TR) rates in the TAC group were significantly higher than those in the CYC group at 1 and 2 months (p < 0.01) and the MMF group at 1–4 months (p < 0.01). The TR rates were 83.3%, 73.3%, and 70.0% in the TAC, CYC, and MMF groups at 9 months (p = 0.457), and there were no significant differences between the three groups from 5 to 9 months. Furthermore, TAC reduced proteinuria and ameliorated hypoalbuminemia more quickly and effectively than CYC and MMF. We observed no severe adverse events in the three groups.
Conclusion: Tacrolimus combined with corticosteroid had tolerable adverse effects and induced the remission of IMN more effectively and more rapidly. This is the first prospective randomized cohort study to compare three different therapies in patients at high risk for IMN. It provides strong evidence for choosing optimal treatment for patients with IMN. The long-term efficacy of this treatment strategy should be investigated further in future studies. |
| first_indexed | 2024-12-14T10:16:03Z |
| format | Article |
| id | doaj.art-ce0dccf043e64418b8fb773c13991bd8 |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-14T10:16:03Z |
| publishDate | 2016-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-ce0dccf043e64418b8fb773c13991bd82022-12-21T23:06:50ZengElsevierJournal of the Formosan Medical Association0929-66462016-01-011151111810.1016/j.jfma.2015.07.021Comparison of different therapies in high-risk patients with idiopathic membranous nephropathyLei PengShi-Yao WeiLei-Ting LiYi-Xin HeBing LiImmunosuppressive therapy plays an important role in patients with high-risk idiopathic membranous nephropathy (IMN), but the therapeutic modality is still controversial. Methods: Corticosteroid combined with oral tacrolimus (TAC, target trough blood concentration of 4–8 ng/mL), intravenous cyclophosphamide (CYC, 750 mg/m2/mo, or oral mycophenolate mofetil (MMF, 1.5–2.0 g/d) were randomly administered for 9 months to 90 patients with IMN proved with renal biopsy with severe proteinuria (>8 g/d). Results: Eighty-six of the 90 patients completed the study. The total remission (TR) rates in the TAC group were significantly higher than those in the CYC group at 1 and 2 months (p < 0.01) and the MMF group at 1–4 months (p < 0.01). The TR rates were 83.3%, 73.3%, and 70.0% in the TAC, CYC, and MMF groups at 9 months (p = 0.457), and there were no significant differences between the three groups from 5 to 9 months. Furthermore, TAC reduced proteinuria and ameliorated hypoalbuminemia more quickly and effectively than CYC and MMF. We observed no severe adverse events in the three groups. Conclusion: Tacrolimus combined with corticosteroid had tolerable adverse effects and induced the remission of IMN more effectively and more rapidly. This is the first prospective randomized cohort study to compare three different therapies in patients at high risk for IMN. It provides strong evidence for choosing optimal treatment for patients with IMN. The long-term efficacy of this treatment strategy should be investigated further in future studies.http://www.sciencedirect.com/science/article/pii/S0929664615002776cyclophosphamideidiopathic membranous nephropathymycophenolate mofetilproteinuriatacrolimus |
| spellingShingle | Lei Peng Shi-Yao Wei Lei-Ting Li Yi-Xin He Bing Li Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy Journal of the Formosan Medical Association cyclophosphamide idiopathic membranous nephropathy mycophenolate mofetil proteinuria tacrolimus |
| title | Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy |
| title_full | Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy |
| title_fullStr | Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy |
| title_full_unstemmed | Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy |
| title_short | Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy |
| title_sort | comparison of different therapies in high risk patients with idiopathic membranous nephropathy |
| topic | cyclophosphamide idiopathic membranous nephropathy mycophenolate mofetil proteinuria tacrolimus |
| url | http://www.sciencedirect.com/science/article/pii/S0929664615002776 |
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