Stepwise treatment using corticosteroids alone and in combination with cyclosporine in korean patients with idiopathic membranous nephropathy - PubMed (original) (raw)

Observational Study

doi: 10.3349/ymj.2013.54.4.973.

Mi Jung Lee, Hyung Jung Oh, Hyang Mo Koo, Fa Mee Doh, Hyoung Rae Kim, Jae Hyun Han, Jung Tak Park, Seung Hyeok Han, Kyu Hun Choi, Tae-Hyun Yoo, Shin-Wook Kang

Affiliations

Observational Study

Stepwise treatment using corticosteroids alone and in combination with cyclosporine in korean patients with idiopathic membranous nephropathy

Dong Ho Shin et al. Yonsei Med J. 2013 Jul.

Abstract

Purpose: We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome.

Materials and methods: The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50% or initiation of dialysis, and all-cause mortality. Seventy-two (40.2%) and 50 (27.9%) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8%) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50% from baseline by corticosteroids alone within 3 months.

Results: There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1%) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5%, 86.2%, and 56.7% (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7%, 79.9%, and 57.2% (p=0.01).

Conclusion: Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.

Keywords: Corticosteroids; cyclosporine; idiopathic membranous nephropathy; nephrotic syndrome; remission.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1

Fig. 1

Flow-chart of the enrolment procedure. A total of 470 patients were diagnosed as membranous nephropathy (MN). Patients with an age of less than 18 years, patients with other diseases including systemic lupus erythematosus, diabetes mellitus, and malignancy, patients with previous history of kidney transplantation or exposure to drugs associated with MN, such as gold, penicillamine, and captopril, patients with positive hepatitis B virus antigen or hepatitis C virus antibody, and patients with a follow-up duration of less than 1 year were excluded. Finally, patients with proteinuria of non-nephrotic range were also excluded.

Fig. 2

Fig. 2

Kaplan-Meier plots for cumulative probabilities to achieve complete remission (CR) and to achieve CR or partial remission (PR) according to treatment modalities. (A) Probability to achieve CR was significantly higher in patients treated with corticosteroids alone or with cyclosporine A (CsA) compared to patients with conservative treatment (Tx). (B) Probability to achieve CR or PR was significantly higher in patients treated with corticosteroids alone or with CsA compared to patients with conservative Tx.

Fig. 3

Fig. 3

Kaplan-Meier plots for the composite secondary endpoints, defined as renal outcome and all-cause mortality, according to treatment modalities. The cumulative event-free rates were significantly higher in patients treated with corticosteroids alone or with cyclosporine A (CsA) compared to patients with conservative treatment (Tx).

Fig. 4

Fig. 4

Flow-chart of the treatment regimens and therapeutic duration in patients who experienced relapses. Values are expressed as median (IQR). CsA, cyclosporine A; CTx, cyclophosphamide; MMF, mycophenolate mofetil; IQR, InterQuartile Rate.

Similar articles

Cited by

References

    1. Cattran DC. Idiopathic membranous glomerulonephritis. Kidney Int. 2001;59:1983–1994. - PubMed
    1. Ponticelli C, Passerini P. Can prognostic factors assist therapeutic decisions in idiopathic membranous nephropathy? J Nephrol. 2010;23:156–163. - PubMed
    1. Muirhead N. Management of idiopathic membranous nephropathy: evidence-based recommendations. Kidney Int Suppl. 1999;70:S47–S55. - PubMed
    1. Cameron JS, Healy MJ, Adu D The MRC Glomerulonephritis Working Party. The Medical Research Council trial of short-term high-dose alternate day prednisolone in idiopathic membranous nephropathy with nephrotic syndrome in adults. Q J Med. 1990;74:133–156. - PubMed
    1. Cattran DC, Delmore T, Roscoe J, Cole E, Cardella C, Charron R, et al. A randomized controlled trial of prednisone in patients with idiopathic membranous nephropathy. N Engl J Med. 1989;320:210–215. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources