title: Effect of prolonged tacrolimus treatment in idiopathic membranous nephropathy with nephrotic syndrome.
abstract: OBJECTIVE
  Tacrolimus has been used for idiopathic membranous nephropathy (IMN) therapy, but most patients who achieved remission showed a high relapse rate when tacrolimus was withdrawn after 6-12 months of therapy. We proposed that a prolonged therapeutic course should help reduce the relapse rate.
  
  
  METHODS
  A total of 42 patients with nephrotic syndrome caused by IMN were randomly divided into short-term (n = 20) and long-term (n = 22) groups. All patients received initial treatment with tacrolimus and prednisone for 6 months, and afterward only the long-term patient group was tapered with low-dose tacrolimus until 24 months.
  
  
  RESULTS
  Over 85% of the patients achieved proteinuria reduction, serum albumin improvement and serum lipid recovery; the probability of remission in both groups was over 80% at 6 months. The remission rate was steady at over 80% after 12 and 24 months in the long-term group, but only 50 and 45%, respectively, in the short-term group. Nine patients (45%) relapsed in the short-term group after tacrolimus withdrawal, while not a single patient suffered recurrence in the long-term group. The concentration of tacrolimus remained similar between the two groups at 5-8 ng/ml during the initial 6 months, and was significantly decreased at 12 months compared to 6 months (p < 0.05), along with reduction of oral administration in the long-term group.
  
  
  CONCLUSIONS
  Combined therapy of tacrolimus with prednisone can relieve IMN significantly; prolonged tacrolimus treatment at a low blood concentration can alleviate the illness persistently, with a low recurrence rate and gratifying safety.
authors: Department of Nephrology, Second Hospital of Jilin University, Changchun, China.
authors: Hang
authors: H
authors: Yuan
authors: Nian
authors: N
authors: Liu
authors: Guang-Dong
authors: GD
authors: Sun
authors: Ye
authors: Y
authors: Jia
authors: Ping
authors: P
authors: Luo
authors: Li-Ning
authors: LN
authors: Miao
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D011241:Prednisone / Q000008:administration & dosage*; D011507:Proteinuria / Q000188:drug therapy / Q000378:metabolism; D012709:Serum Albumin / Q000032:analysis; D016559:Tacrolimus / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D012709:Serum Albumin; D011241:Prednisone; D016559:Tacrolimus