Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels
Abstract Rituximab (RTX) and cyclophosphamide (CYC) based treatments are both recommended as first-line therapies in idiopathic membranous nephropathy (IMN) by KDIGO 2021 guideline. However, the efficacy of RTX vs. CYC-based treatments in IMN is still controversial. We performed this systemic review...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-023-03307-x |
| _version_ | 1827724129617313792 |
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| author | Cheng Xue Jian Wang Jinyan Pan Congdie Liang Chenchen Zhou Jun Wu Shuwei Song Linlin Cui Liming Zhang Yawei Liu Bing Dai |
| author_facet | Cheng Xue Jian Wang Jinyan Pan Congdie Liang Chenchen Zhou Jun Wu Shuwei Song Linlin Cui Liming Zhang Yawei Liu Bing Dai |
| author_sort | Cheng Xue |
| collection | DOAJ |
| description | Abstract Rituximab (RTX) and cyclophosphamide (CYC) based treatments are both recommended as first-line therapies in idiopathic membranous nephropathy (IMN) by KDIGO 2021 guideline. However, the efficacy of RTX vs. CYC-based treatments in IMN is still controversial. We performed this systemic review and meta-analysis registered in PROSPERO (CRD 42,022,355,717) by pooling data from randomized controlled trials or cohort studies in IMN patients using the EMBASE, PubMed, and Cochrane libraries (till Orc 1, 2022). The primary outcomes were the complete remission (CR) rate + partial remission (PR) rate. CR rate, immunologic response rate, relapse rate, and the risk of serious adverse events (SAE) were secondary outcomes. Eight studies involving 600 adult patients with IMN were included with a median follow-up duration of 12 to 60 months. RTX induced a similar overall remission rate compared with CYC (RR 0.88, 95% CI: 0.71, 1.09, P = 0.23). At the follow-up time of 6 months, RTX was associated with a lower CR + PR rate compared with CYC (RR 0.67, 95% CI: 0.52, 0.88, P = 0.003). Moreover, RTX might be less effective in inducing CR + PR than CYC treatment in IMN patients with high antiPLA2R antibody levels (RR 0.67, 95% CI: 0.48, 0.94, P = 0.02). The occurrences of CRs, relapse rates, immunologic response rates, and SAE were not significantly different between RTX and CYC, respectively. In conclusion, although the long-term efficacy and safety of CYC compared to RTX were comparable, CYC might respond faster and be more advantageous in IMN patients with high antiPLA2R antibody titers. |
| first_indexed | 2024-03-10T22:09:52Z |
| format | Article |
| id | doaj.art-ecf8e4bb9b7743bba6ab909a935a0df9 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-03-10T22:09:52Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-ecf8e4bb9b7743bba6ab909a935a0df92023-11-19T12:39:15ZengBMCBMC Nephrology1471-23692023-09-0124111310.1186/s12882-023-03307-xCyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levelsCheng Xue0Jian Wang1Jinyan Pan2Congdie Liang3Chenchen Zhou4Jun Wu5Shuwei Song6Linlin Cui7Liming Zhang8Yawei Liu9Bing Dai10Division of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), xuecheng@smmu.edu.cnDepartment of Nephrology, No. 2 People’s Hospital of Fuyang CityDepartment of Outpatient, Jinling HospitalDepartment of Nephrology, Zhabei Central Hospital of Jing’an DistrictDivision of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), xuecheng@smmu.edu.cnDivision of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), xuecheng@smmu.edu.cnDivision of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), xuecheng@smmu.edu.cnDivision of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), xuecheng@smmu.edu.cnDepartment of Nephrology, Zhabei Central Hospital of Jing’an DistrictDivision of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), xuecheng@smmu.edu.cnDivision of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), xuecheng@smmu.edu.cnAbstract Rituximab (RTX) and cyclophosphamide (CYC) based treatments are both recommended as first-line therapies in idiopathic membranous nephropathy (IMN) by KDIGO 2021 guideline. However, the efficacy of RTX vs. CYC-based treatments in IMN is still controversial. We performed this systemic review and meta-analysis registered in PROSPERO (CRD 42,022,355,717) by pooling data from randomized controlled trials or cohort studies in IMN patients using the EMBASE, PubMed, and Cochrane libraries (till Orc 1, 2022). The primary outcomes were the complete remission (CR) rate + partial remission (PR) rate. CR rate, immunologic response rate, relapse rate, and the risk of serious adverse events (SAE) were secondary outcomes. Eight studies involving 600 adult patients with IMN were included with a median follow-up duration of 12 to 60 months. RTX induced a similar overall remission rate compared with CYC (RR 0.88, 95% CI: 0.71, 1.09, P = 0.23). At the follow-up time of 6 months, RTX was associated with a lower CR + PR rate compared with CYC (RR 0.67, 95% CI: 0.52, 0.88, P = 0.003). Moreover, RTX might be less effective in inducing CR + PR than CYC treatment in IMN patients with high antiPLA2R antibody levels (RR 0.67, 95% CI: 0.48, 0.94, P = 0.02). The occurrences of CRs, relapse rates, immunologic response rates, and SAE were not significantly different between RTX and CYC, respectively. In conclusion, although the long-term efficacy and safety of CYC compared to RTX were comparable, CYC might respond faster and be more advantageous in IMN patients with high antiPLA2R antibody titers.https://doi.org/10.1186/s12882-023-03307-xRituximabMembranous nephropathyCyclophosphamideMeta-analysisTreatment |
| spellingShingle | Cheng Xue Jian Wang Jinyan Pan Congdie Liang Chenchen Zhou Jun Wu Shuwei Song Linlin Cui Liming Zhang Yawei Liu Bing Dai Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels BMC Nephrology Rituximab Membranous nephropathy Cyclophosphamide Meta-analysis Treatment |
| title | Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels |
| title_full | Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels |
| title_fullStr | Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels |
| title_full_unstemmed | Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels |
| title_short | Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels |
| title_sort | cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti pla2r antibody levels |
| topic | Rituximab Membranous nephropathy Cyclophosphamide Meta-analysis Treatment |
| url | https://doi.org/10.1186/s12882-023-03307-x |
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