title: Triple therapy with single daily dose of cyclosporine in Japanese patients with idiopathic membranous nephropathy.
abstract: OBJECTIVE
  The optimal therapeutic approach to patients with idiopathic membranous nephropathy (IMN) remains controversial. In this study, we assessed the efficacy of single daily dose cyclosporine (CsA) combined with low-dose prednisolone (PSL) and an angiotensin II receptor blocker (ARB) in patients with IMN.
  
  
  METHODS
  We studied 13 nephrotic patients (8 men, 5 women) with IMN diagnosed on biopsy. An initial single daily dose of 2 mg/kg, but not exceeding 150 mg, CsA was given for 12 months, tapered by a 25 mg reduction every 2 months. An initial twice-daily dose of 0.5 mg/kg PSL was given for 2 months and was also tapered. An ARB was given to all patients and the same dosage was used throughout the study. Patients were followed up for 6 to 66 months.
  
  
  RESULTS
  Nine patients achieved complete remission at 6.7±2.9 months, and incomplete remission was obtained in the remaining patients. After a follow-up period of 32.7±20.0 months, their serum creatinine and estimated glomerular filtration rate values were similar to baseline levels. The 9 patients who completed the treatment course have not relapsed. Moreover, there were no adverse effects requiring discontinuation of this triple therapy.
  
  
  CONCLUSIONS
  A single daily dose of CsA combined with a low dose of PSL and an ARB in new-onset nephrotic patients with IMN induced a high remission rate of nephrotic syndrome, with a low incidence of relapse and a low risk of adverse effects. The triple therapy and prospective follow-up shows potential as a treatment approach for patients with IMN.
authors.affiliation: Department of Nephrology, Tokyo Medical University, Japan. mhiroshi@tokyo-med.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Yume
authors.initials: Y
authors.lastname: Nagaoka
authors.forename: Tomonari
authors.initials: T
authors.lastname: Okada
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Wada
authors.forename: Asako
authors.initials: A
authors.lastname: Gondo
authors.forename: Shinga
authors.initials: S
authors.lastname: Esaki
authors.forename: Ami
authors.initials: A
authors.lastname: Hayashi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Miyaoka
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D001706:Biopsy; D016572:Cyclosporine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy* / Q000208:ethnology*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007564:Japan; D007668:Kidney; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone