The Combination Therapy of Glucocorticoids, Tacrolimus, and Mycophenolate Mofetil in Primary Membranous Nephropathy Coexisting with Type 2 Diabetes Mellitus: A Retrospective Study

Abstract

Background: Primary membranous nephropathy (pMN) is treated with glucocorticoids or immunosuppressive agents, depending on the disease severity. However, treating pMN with type 2 diabetes mellitus (T2DM) remains challenging. Methods: We retrospectively collected and analyzed the data of patients diagnosed with pMN and T2DM. The low-dose multitarget regimen consists of prednisone (10 mg/d), tacrolimus (0.05 mg/kg/d, blood concentration 5–10 ng/mL), and mycophenolate mofetil (1 g/d); The cyclophosphamide (CTX) regimen consists of prednisone (initial dose 1 mg/kg/d) and CTX (0.8–1.0 g/month, cumulative dose 6–9 g). Results: Sixty-seven patients were diagnosed with pMN and T2DM, and 28 were enrolled in this study, with 14 cases each in the low-dose multitarget and CTX groups. Urinary protein excretion decreased significantly in both groups after treatment, which was significantly greater in the low-dose multitarget group than that in the CTX group (2 months: −4800.48 ± 3002.65 mg/24h versus −1663.32 ± 4113.98 mg/24h, P−BH = 0.045; 12 months: −7289.25 ± 2520.92 mg/24h versus −4512.79 ± 3448.85 mg/24h, P−BH = 0.044). Serum albumin levels increased more in the low-dose multitarget group than in the CTX group, although the difference was not significant. Patients treated with glucocorticoids plus CTX had worse glycemic control in two months. Conclusion: The combination of glucocorticoids, tacrolimus, and mycophenolate mofetil was effective for treating pMN with T2DM and not inferior to the CTX regimen in proteinuria reduction. Further studies are needed to confirm the regimen's influence on blood glucose and long-term efficacy.