Early initiation of tacrolimus or cyclophosphamide therapy for idiopathic membranous nephropathy with severe proteinuria

Background: Early initiation of therapy is warranted for patients with idiopathic membranous nephropathy (IMN) who have severe proteinuria. Therapy with tacrolimus (TAC) or intravenous cyclophosphamide (CYC) may be an option in treating such patients. Methods: This prospective cohort study included patients with IMN whose daily proteinuria was greater than 6.0 g with 3-6 months observation of nonimmunosuppressive therapy. One cohort received prednisone combined with oral TAC (target trough blood level of 4-8 ng/mL) for 24 weeks. The other cohort received prednisone combined with intravenous CYC (750 mg/m(2) body surface) every 2 weeks for the first 8 weeks and then once per 4 weeks for the next 16 weeks. Results: Thirty patients met criteria for enrollment, and 25 patients completed therapy. The results of the 24-week therapeutic period were complete remission (CR) 4 patients (30.8%) on CYC and 8 patients (66.7%) on TAC; partial remission (PR) 7 patients (53.8%) ton CYC and 3 patients (25%) on TAC; no response 2 patients (15.4%) on CYC and 1 patient (8.3%) on TAC. The,percentages of remission (either PR or CR) by 4 and 8 weeks were significantly higher in TAC group than in CYC group (p <= 0.05). The probability of CR was significantly higher in the TAC group than in the CYC group (p=0.018, by log-rank test). Conclusion: Earlier initiation of therapy with TAC or intravenous CYC (combined steroid) for 24 weeks was useful for Chinese adults with IMN in inducing remission of severe proteinuria, and quicker remission was seen in TAC therapy.