Efficacy and safety of tacrolimus‐based treatment for nephrotic idiopathic membranous nephropathy in young adults: A retrospective study

Abstract

In China, the prevalence of idiopathic membranous nephropathy (IMN) is increasing with a younger age of onset. From January 2012 to October 2018, biopsy‐proven nephrotic IMN patients aged between 15 and 40 in Taian City Central Hospital treated with tacrolimus (TAC) were retrospectively analyzed. Twelve‐month follow‐up data were collected. A total of 86 patients were enrolled in this study. Forty patients in the TAC group received TAC monotherapy with an initial dose of 0.05 to 0.1 mg/kg/day. Forty‐six patients in the TAC + Pred group received TAC combined with oral prednisone (0.5 mg/kg/day initially). Remission rate, relapse rate, and adverse events in the two groups were assessed. Total remission (TR) rates at the end of the 3rd, 6th, and 12th month were 15%, 35%, and 77.5% (TAC group) and 28.3%, 56.5%, and 80.4% (TAC + Pred group), respectively. Compared with the TAC group, the TAC + Pred group had higher complete remission rates at the end of the 6th and 12th month, and TR rate at the 6th month was significantly higher. Twenty‐four‐hour urinary protein excretion, serum albumin and estimated glomerular filtration rate between the two groups were comparable during the follow‐up. Decrease in proteinuria was significantly greater in the TAC + Pred group. No significant difference of relapse rate was found between the two groups. Adverse effects in the two groups were mild and controllable. Both TAC monotherapy and TAC combined with medium‐dose prednisone are effective and safe for young adults with nephrotic IMN, while TAC + Pred regimen brings more benefits.

Anti-phospholipase A2 receptor antibody levels at diagnosis predicts outcome of TAC-based treatment for idiopathic membranous nephropathy patients

“…Thus, TAC can reduce urinary protein excretion and is widely used in the treatment of nephrotic syndrome. A number of studies have shown that TAC, either monotherapy or in combination with low-dose corticosteroids, was effective in treating iMN patients [ 9 , 27 , 28 ]. Praga et al used TAC monotherapy in iMN patients with normal kidney function and mean proteinuria over 12 months with a 6-month taper and compared them to conservation-treated patients.…”

“…After 18 months, the total remission rate was 94% in the TAC group, but only 35% in the control group [ 9 ]. A retrospective study by Zhao Hu et al recently showed that both TAC monotherapy and TAC combined with medium-dose prednisone in young patients aged between 15 and 40 years for 12 months led to 77.5%-80.4% remission rates [ 27 ].Thus, the KDIGO 2012 glomerular diseases guideline included TAC as one of the first-line immunosuppressive treatments for iMN patients [ 11 ], and KDIGO 2021 continued this proposition [ 10 ].…”

Efficacy and safety of tacrolimus monotherapy versus tacrolimus-corticosteroid combination therapy for idiopathic membranous nephropathy

“…Some patients may have PR or CR after 6 months. In the included studies of Shang Shunlai and Zhang Xiaojuan, after TAC monotherapy or combination therapy, the TR at the tenth to twelfth month was higher than the TR at the sixth month [15,17] . However, TAC monotherapy had similar TR compared with TAC-corticosteroid combination therapy at the tenth to twelfth month [15,17] .…”

“…In the included studies of Shang Shunlai and Zhang Xiaojuan, after TAC monotherapy or combination therapy, the TR at the tenth to twelfth month was higher than the TR at the sixth month. [ 15 , 17 ] However, TAC monotherapy had similar TR compared with TAC-corticosteroid combination therapy at the tenth to twelfth month. [ 15 , 17 ] More studies are needed to prove that TAC-corticosteroid combination therapy may have stronger immunosuppressive effects than TAC monotherapy for IMN.…”

“…[ 15 , 17 ] However, TAC monotherapy had similar TR compared with TAC-corticosteroid combination therapy at the tenth to twelfth month. [ 15 , 17 ] More studies are needed to prove that TAC-corticosteroid combination therapy may have stronger immunosuppressive effects than TAC monotherapy for IMN.…”