Effectiveness and safety of cyclophosphamide or tacrolimus therapy for idiopathic membranous nephropathy

Zou, Honghong; Jiang, Fang; Xu, Gaosi

doi:10.1080/0886022x.2019.1637758

Cited by 11 publications

(8 citation statements)

References 20 publications

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“…The time to achieve overall remission in different groups was 3 months in the TAC group, 5 months in the CTX group, and 6 months in the RTX group, indicating that TAC achieved ovreall remission faster than the other two groups, consistented with the related study [10,17] suggesting that the short-term effect of TAC was better. Both STARTMEN [18] and RI-C YCLO [9] showed that the glucocorticoid-CTX induced a remission trend faster than RTX, that consistent with the results of this study.…”

Section: Discussionsupporting

confidence: 79%

“…Previous treatment options for IMN mainly included calmodulin inhibitors, and glucocorticoidcyclophosphamide.As Beck et al [7] detected that 70% of IMN patients had positive serum PLA2R antibody, great changes had taken place in the treatment of IMN. RTX was widely used in the treatment of IMN, and KDIGO guideline [3] recommended using RTX for the treatment of IMN There have been many reports on the pairwise comparison of the therapeutic effects of the three therapeutic regimens.The study results of ZOU [10] suggested that TAC took effect more quickly than CTX, and its e cacy was better than CTX in the short term.The study of RI-CYCLO (Rituximab or Cyclophosphamide in the Treatment of Membranous Nephropathy) [9] compared the e cacy of RTX and glucocorticoid-CTX,the results showed no statistical difference between RTX and CTX. So we speculated that TAC was better than RTX in treating IMN.But…”

Section: Discussionmentioning

confidence: 94%

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Efficacy of rituximab, tacrolimus and cyclophosphamide in the treatment of idiopathic membranous nephropathy and its influencing factors: Retrospective cohort study

Jin,

Jiang,

Lan

et al. 2024

Preprint

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Backround To investigate the efficacy of rituximab, tacrolimus, and cyclophosphamide on idiopathic membranous nephropathy (IMN) and the related factors for efficacy. Methods A total of 117 patients diagnosed with IMN by renal biopsy or positive anti-phospholipase antibody from January 2018 to December 2022, tacrolimus, cyclophosphamide, or rituximab were selected as initial immunotherapy. The remission of proteinuria and infection were followed up. Survival analysis was used to explore the difference in the remission rate of proteinuria among the three groups, and Cox regression model was used to explore the risk factors of IMN treatment effect, and the difference in infection among the three groups was compared. ResultsAmong the 117 IMN patients, tacrolimus, cyclophosphamide and rituximab were selected for initial immunotherapy in 32, 63, and 22 patients, respectively.In the tacrolimus group, the total response rate of proteinuria at 6 months was 84.4%, the median response time was 3 months, and the complete response rate of proteinuria was 44.4%. The total remission rate of proteinuria was 82.5%, the median remission time was 5 months, and the complete remission rate of proteinuria was 40.9% in the cyclophosphamide group. The total remission rate of proteinuria at 6 months in the rituximab group was 72.7%, the median response time was 6 months, and the complete response rate of proteinuria was 42.9%. Multivariate Cox regression analysis showed that: In the first 6 months of initial treatment, the regimen affected on total renal response(HR=0.67, 95%CI 0.48-0.93, P= 0.02), and TAC had a better effect than RTX (HR=2.14, 95%CI 1.01-4.19, P=0.03). There was no difference between CTX and RTX. Serum albumin level at immunotherapy had a statistical effect on total renal response (HR=1.05, 95%CI 1.00-1.09, P = 0.04), and patients with serum albumin > 20g/L at immunotherapy had a better overall renal response rate. Conclusion The therapeutic effect of IMN was affected by the treatment regimen and the onset of serum albumin. Tacrolimus had a better effect than rituximab, and there was no difference between tacrolimus and cyclophosphamide. There was no difference in infection among the three groups.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 94%

Efficacy of rituximab, tacrolimus and cyclophosphamide in the treatment of idiopathic membranous nephropathy and its influencing factors: Retrospective cohort study

Jin,

Jiang,

Lan

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Alternating monthly cycles of alkylating agents [especially cyclophosphamide (CTX)] and corticosteroids has been proven to be more effective than corticosteroids alone in inducing remissions and preserving renal function [9,10] . However, CTX is accompanied by frequent adverse drug reactions.…”

Section: Introductionmentioning

confidence: 99%

“…[8] Alternating monthly cycles of alkylating agents [especially cyclophosphamide (CTX)] and corticosteroids has been proven to be more effective than corticosteroids alone in inducing remissions and preserving renal function. [9,10] However, CTX is accompanied by frequent adverse drug reactions. For patients who cannot tolerate or refuse to CTX treatment, calcineurin inhibitors (CNIs), including cyclosporine (CSA) and tacrolimus (TAC), are suggested to be promising alternatives.…”

Section: Introductionmentioning

confidence: 99%

Comparison of cyclophosphamide and calcineurin inhibitors for idiopathic membranous nephropathy

Yu²,

Gao³

et al. 2022

Medicine

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Background:Idiopathic membranous nephropathy (IMN) is one of the leading causes of nephrotic syndrome in adults. We performed a protocol for systematic review and meta-analysis to compare the efficacy and safety of cyclophosphamide (CTX) with calcineurin inhibitors (CNIs) in the treatment of IMN.Methods:PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and 3 Chinese databases (WanFang Data, Chongqing VIP and China National Knowledge Infrastructure) were searched from inception through January 2022 to identify randomized controlled trials that compared CTX with CNIs for patients with IMN. Systematic review and meta-analysis of the data will be performed in RevMan software (version 5.3) according to the preferred reporting items of systematic reviews and meta-analysis guidelines. Two authors independently performed the literature searching, data extraction, and quality evaluation. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials.Results:The results will be submitted to a peer-reviewed journal once completed.Conclusion:The conclusion of our research will provide evidence to help physicians to decide between CTX and CNIs therapy regimens for IMN patients.Open Science Framework registration number:10.17605/OSF.IO/G584K

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“…Glucocorticoid therapy alone has difficulty achieving ideal effects in IMN, and comprehensive intervention combined with immunosuppressants is usually needed[ 3 ]. Cyclophosphamide is commonly used in IMN and can achieve certain therapeutic effects, but the incidence of adverse reactions is high.…”

Section: Introductionmentioning

confidence: 99%

Effect of Nephritis Rehabilitation Tablets combined with tacrolimus in treatment of idiopathic membranous nephropathy

Lv¹,

Wang²,

Zhang³

et al. 2021

WJCC

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BACKGROUND Idiopathic membranous nephropathy (IMN) has a high incidence in the middle-aged and elderly population, and poses a great threat to the physical and mental health and quality of life of patients. Nephritis Rehabilitation Tablets have many potential effects, such as clearing residual toxins, tumefying the kidney and spleen, replenishing qi, and nourishing yin, and have played an important role in the treatment of a variety of kidney diseases. AIM To investigate the efficacy and safety of Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN. METHODS Eighty-four patients with IMN recruited from January 2017 to September 2020 were randomly divided into a study group ( n = 42) and a control group ( n = 42). On the basis of routine symptomatic treatment, both groups were treated with tacrolimus, and the study group was additionally treated with Nephritis Rehabilitation Tablets. Both groups were treated for 12 wk. The therapeutic effect, the levels of renal function indexes [serum creatinine (Scr), serum albumin, and 24-h urinary protein], urinary immunoglobulin (IgG4), membrane attack complex (C5b-9), and the incidence of adverse reactions were measured before and after 12 wk of treatment. RESULTS The total effective rate in the study group was significantly higher than that of the control group. Before treatment, there was no significant difference in Scr, serum albumin, or 24 h urinary protein between the two groups. After 12 wk of treatment, the levels of Scr and 24-h urinary protein in both groups were significantly lower and serum albumin was significantly higher than those before treatment ( P < 0.05), and the levels of Scr and 24-h urinary protein were significantly lower ( P = 0.003 and 0.000, respectively), and the level of serum albumin was significantly higher ( P = 0.00) in the study group than in the control group. Before treatment, there was no significant difference in urinary IgG4 and C5b-9 levels between the study group and the control group ( P = 0.336 and 0.438, respectively). After 12 wk of treatment, the levels of urinary IgG4 and C5b-9 in the two groups were lower than those before treatment, and the levels of urinary IgG4 and C5b-9 in the study group were significantly lower than those in the control group ( P = 0.000). There was no significant difference in the incidence of adverse reactions between the two groups ( P = 0.710). CONCLUSION Based on routine intervention, Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN can effectively improve the renal function of patients and downregulate the expression of urinary IgG4 and C5b-9. In addition, they can improve the overall therapeutic...

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Effectiveness and safety of cyclophosphamide or tacrolimus therapy for idiopathic membranous nephropathy

Cited by 11 publications

References 20 publications

Efficacy of rituximab, tacrolimus and cyclophosphamide in the treatment of idiopathic membranous nephropathy and its influencing factors: Retrospective cohort study

Efficacy of rituximab, tacrolimus and cyclophosphamide in the treatment of idiopathic membranous nephropathy and its influencing factors: Retrospective cohort study

Comparison of cyclophosphamide and calcineurin inhibitors for idiopathic membranous nephropathy

Effect of Nephritis Rehabilitation Tablets combined with tacrolimus in treatment of idiopathic membranous nephropathy

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