title: Comparison of different therapies in high-risk patients with idiopathic membranous nephropathy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Nephrology, 2nd Affiliated Hospital, Harbin Medical University, Harbin, People's Republic of China.
authors: Lei
authors: L
authors: Peng
authors: Department of Nephrology, 2nd Affiliated Hospital, Harbin Medical University, Harbin, People's Republic of China.
authors: Shi-Yao
authors: SY
authors: Wei
authors: Department of Nephrology, 2nd Affiliated Hospital, Harbin Medical University, Harbin, People's Republic of China.
authors: Lei-Ting
authors: LT
authors: Li
authors: Department of Nephrology, 2nd Affiliated Hospital, Harbin Medical University, Harbin, People's Republic of China.
authors: Yi-Xin
authors: YX
authors: He
authors: Department of Nephrology, 2nd Affiliated Hospital, Harbin Medical University, Harbin, People's Republic of China. Electronic address: icecreamlee@hotmail.com.
authors: Bing
authors: B
authors: Li
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D002681:China; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy; D012074:Remission Induction; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: cyclophosphamide; idiopathic membranous nephropathy; mycophenolate mofetil; proteinuria; tacrolimus