A Randomized Pilot Trial Comparing Methylprednisolone Plus a Cytotoxic Agent Versus Synthetic Adrenocorticotropic Hormone in Idiopathic Membranous Nephropathy

Ponticelli, Claudio; Passerini, Patrizia; Salvadori, Maurizio; Manno, Carlo; Viola, Battista Fabio; Pasquali, Sonia; Mandolfo, Salvatore

doi:10.1053/j.ajkd.2005.10.016

Cited by 162 publications

(155 citation statements)

References 16 publications

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“…[55][56][57] In case reports from Europe, adrenocorticotropic hormone (ACTH) shows promising results in patients with nephrotic syndrome of various etiologies, including membranous nephropathy, membranoproliferative glomerulonephritis, minimal change disease, and focal segmental glomerulosclerosis. 58,59 In a randomized trial in idiopathic membranous nephropathy conducted by Ponticelli et al, 60 ACTH and cyclophosphamide achieved equal rates of disease remission. Acthar gel, an ACTH formulation available in the United States with Food and Drug Adminstration approval for treating resistant nephrotic syndrome and SLE, may emerge as another potential treatment option for lupus nephritis, particularly class V lupus nephritis.…”

Section: Newer Agents For Lupus Nephritis Will Be Tested In Combinatimentioning

confidence: 98%

Updates on the Treatment of Lupus Nephritis

Bomback

Appel

2010

Journal of the American Society of Nephrology

157

139

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Section: Newer Agents For Lupus Nephritis Will Be Tested In Combinatimentioning

confidence: 98%

Updates on the Treatment of Lupus Nephritis

Bomback

Appel

2010

Journal of the American Society of Nephrology

157

139

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“…16 A number of therapeutic measures using glucocorticoids, 9,10 alkylating agents, 9,10 calcineurin inhibitors, 11,12,29-31 mycophenolate mofetil (MMF), 13,32 and rituximab 8,33 have been published. Among them, the 6-month course of alternating months of glucocorticoids and cyclophosphamide described by Ponticelli et al 10 seems to be a first-line regimen because it offers higher remission rates and long-term benefits, including increased quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Conversely, good response to therapy is associated with better renal survival. 6,7 Despite the recent utilization of new drugs and regimens, [8][9][10][11][12][13] the appropriate treatment for idiopathic MN remains controversial. [14][15][16] A proportion of patients with IMN and nephrotic syndrome experience spontaneous remission, 17,18 and immunosuppressive agents have appreciable toxicity.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of mizoribine followed by low-dose prednisone in patients with idiopathic membranous nephropathy and nephrotic-range proteinuria

Matsumoto¹,

Shimada²,

Nojima³

et al. 2013

Renal Failure

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Efficacy of mizoribine followed by low-dose prednisone in patients with idiopathic membranous nephropathy and nephrotic-range proteinuria, Renal Failure, 35:7,[936][937][938][939][940][941] Background: Idiopathic membranous nephropathy (IMN) patients with persistent high-grade proteinuria are at the highest risk for developing end-stage renal failure. We previously reported the effects of treatment with mizoribine followed by low-dose prednisone treatment in 4 IMN patients. The purpose of the present study was to further assess the effects of this combined treatment in a larger study group. Method: Thirteen patients with IMN and nephroticrange proteinuria received combined treatment. Mizoribine was initiated at a dose of 150 mg/ day, and 2-3 months later, 20 mg/day prednisone was added to the mizoribine regimen. The dosage of prednisone and/or mizoribine was tapered according to the urinary proteinto-creatinine ratio (P/C). We evaluated patient responses for up to 12 months after the initiation of combination therapy. Results: Before treatment, patient urinary P/C ranged from 3.7 to 15.9 g/g. Although these values did not decrease during mizoribine monotherapy, all patients showed dramatic P/C decreases over the course of combination therapy. At 3, 6, and 12 months after combination therapy, 15%, 31%, and 62% of patients attained complete remission, respectively, and all patients were in partial or complete remission 6 months after combination therapy. No notable side effects were observed. Conclusion: The addition of prednisone after mizoribine monotherapy can be beneficial for all IMN patients with nephrotic-range proteinuria syndrome. The risks associated with immunotherapy can be decreased by initially prescribing mizoribine alone, which might act as a base for establishing therapy, followed by low-dose prednisone treatment.

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“…Optimal dosing regimen, retreatment schedule, and long term effects, however, are yet to be corroborated by large trials. Finally, synthetic ACTH has been shown to be effective in reducing proteinuria (28)(29)(30) and similar results are evident with use of ACTH gel in the United States; however studies are small, and long term outcomes have not been determined (31).…”

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confidence: 87%