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/m2 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%) on 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<or=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).


CONCLUSIONS
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.
Li
X
X
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou - PR China.
Lv
R
R
He
Q
Q
Li
H
H
Du
X
X
Lin
W
W
Li
Q
Q
He
X
X
Wang
S
S
Chen
J
J
D003520:Cyclophosphamide / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007668:Kidney / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology* / Q000652:urine; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011241:Prednisone; D016559:Tacrolimus