Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy

被引:43
作者
Peng, Lei [1 ]
Wei, Shi-Yao [1 ]
Li, Lei-Ting [1 ]
He, Yi-Xin [1 ]
Li, Bing [1 ]
机构
[1] Harbin Med Univ, Affiliated Hosp 2, Dept Nephrol, 246 Xuefu Rd, Harbin 150086, Peoples R China
基金
中国博士后科学基金; 中国国家自然科学基金;
关键词
cyclophosphamide; idiopathic membranous nephropathy; mycophenolate; mofetil; proteinuria; tacrolimus; RANDOMIZED CONTROLLED-TRIAL; FOCAL SEGMENTAL GLOMERULOSCLEROSIS; MYCOPHENOLATE-MOFETIL; NEPHROTIC SYNDROME; LUPUS NEPHRITIS; IMMUNOSUPPRESSIVE TREATMENT; CYCLOPHOSPHAMIDE THERAPY; TACROLIMUS TREATMENT; RENAL-FUNCTION; PROTEINURIA;
D O I
10.1016/j.jfma.2015.07.021
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background/Purpose: 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/m(2)/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. Copyright (C) 2015, Formosan Medical Association. Published by Elsevier Taiwan LLC. All rights reserved.
引用
收藏
页码:11 / 18
页数:8
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