Tacrolimus combined with corticosteroids versus Modified Ponticelli regimen in treatment of idiopathic membranous nephropathy: Randomized control trial

• DOI: 10.1111/nep.12569
• Publication Date: 2015-07-24T02:22:58Z
• Authors: Raja Ramachandran; Harsha Kumar Hn; Vinod Kumar; Ritambhra Nada; Ashok Kumar Yadav; Ajay Goyal; Vivek Kumar; Manish Rathi; Vivekanand Jha; Krishan Lal Gupta; Vinay Sakhuja; Harbir Singh Kohli
• Keywords: Membranous Nephropathy; Regimen

There have been very few studies comparing cyclophosphamide (CTX) and calcineurin inhibitor based regimens in the management of non-immunosuppressive symptomatic therapy (NIST) resistant idiopathic membranous nephropathy (IMN). The present study was aimed at efficacy safety tacrolimus (TAC)/steroids with cyclical CTX/steroids (Modified Ponticelli regimen (MPR)) patients IMN.Idiopathic (n = 70) persistent nephrotic syndrome after least 6 months antiproteinuric or complications were equally randomized to receive TAC oral prednisolone (TAC*) MPR. Antibodies against m-type phospholipase A2 receptor (PLA2R Ab) tested for baseline and, 12 start therapy. primary end point achievement remission secondary objectives adverse effects estimated glomerular filtration rate both groups.Intention-to-treat analysis showed that remissions (74% TAC* vs. 60% MPR; P 0.30) (71% 77% 0.78) comparable. PLA2R Ab titres 6/12 correlated urine protein (r 0.54/0.58) serum albumin -0.49/-0.53) Patients on CTX had a significantly higher risk amenorrhea while those greater reversible nephrotoxicity.In NIST refractory IMN, MPR are comparable, but different effect profile. PLA2 R has good association proteinuria, should be regularly monitored clinical follow-up.