Efficacy of different regimens for treatment of idiopathic membranous nephropathy

treatment regimens for idiopathic membranous nephropathy (IMN) are heavily debated. To date, a consensus on first-line treatment has not been reached. This study aimed to explore the optimal treatment for IMN patients by comparing the efficacy and safety of five treatment methods. Records of 107 patients with IMN proved by renal biopsy in our hospital from January 2004 to January 2016 were retrospectively reviewed. Twenty-two patients received oral prednisone combined with oral cyclophosphamide (group A); 20 patients were treated with oral prednisone combined with intravenous cyclophosphamide (group B). The modified Ponticelli protocol was administered to 19 patients (group C); 21 patients received oral prednisone and intravenous cyclosporine A (group D); 25 patients received oral prednisone combined with oral tacrolimus (group E). Efficacy evaluated by the multilevel model analysis showed that the no remission (NR) rate of female patients with normal lipid values, who had received regimen E was remarkably lower than that in other regimens (compared to group E, A: OR=2.250, X-2=5.044, P=0.025; B: OR=2.063, X-2=4.001, P=0.045; C: OR=2.286, X-2=4.947, P=0.026; D: OR=1.160, X-2=0.159, P=0.048, respectively). We observed no significant differences in the incidence of adverse events and relapse rate among the five groups (P>0.05). Immunosuppressive treatment with tacrolimus and prednisone seems to be more effective and well tolerated by patients with IMN.