Calcineurin inhibitors versus cyclophosphamide for idiopathic membranous nephropathy: A systematic review and meta-analysis of 21 clinical trials

Qiu, Ting; Zhang, Chao; Zhao, Hong; Zhou, Jun

doi:10.1016/j.autrev.2016.12.005

Cited by 44 publications

(40 citation statements)

References 27 publications

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“…The second point of our study was to investigate the therapeutic prognosis between two immunosuppressant regimens in PLA2R‐associated IMN. Both CTX and CsA were the first line initial immunosuppressive therapy protocol for IMN, with similar remission rate according to previous findings . However, there is a paucity of studies regarding the difference of therapeutic prognosis between CTX and CsA in PLA2R‐associated IMN.…”

Section: Discussionsupporting

confidence: 72%

“…Both CTX and CsA were the first line initial immunosuppressive therapy protocol for IMN, with similar remission rate according to previous findings. 14…”

Section: Discussionmentioning

confidence: 99%

“…13 Cyclosporine A (CsA) is an alternative regimen for the initial therapy of IMN, with a comparable remission rate compared with CTX. 14 CsA have been demonstrated to suppress T cell responses through calcineurin-phosphatase pathway and the nuclear translocation of nuclear factor of activated T-cells (NFAT). 15,16 However, in PLA2R-associated IMN, the difference of therapeutic effects between CTX and CsA had not been investigated.…”

Section: Introductionmentioning

confidence: 99%

“…As the main alkylating agents, cyclophosphamide (CTX) could inhibit lymphocyte proliferation, rapidly depleting B and T cells and further suppressing humoral and cellular immunity . Cyclosporine A (CsA) is an alternative regimen for the initial therapy of IMN, with a comparable remission rate compared with CTX . CsA have been demonstrated to suppress T cell responses through calcineurin‐phosphatase pathway and the nuclear translocation of nuclear factor of activated T‐cells (NFAT) .…”

mentioning

confidence: 99%

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Clinical value of renal phospholipase A2 receptor deposit in the prognosis evaluation and treatment options of idiopathic membranous nephropathy: A retrospective cohort study

Xie

Dong

et al. 2020

Nephrology

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Aim Phospholipase A2 receptor (PLA2R) is a target antigen for idiopathic membranous nephropathy (IMN). However, the association between renal PLA2R antigen and disease prognosis had not been fully investigated. In addition, there was a paucity of studies investigating the difference of therapeutic effects between cyclophosphamide and cyclosporine A in PLA2R‐associated IMN. Methods This retrospective cohort study recruited 300 eligible patients diagnosed with biopsy‐proven IMN between September 2015 and July 2018 in Guangdong Provincial People's Hospital. The remission of proteinuria was compared between PLA2R‐associated and non‐PLA2R‐associated IMN. The difference of therapeutic effects between cyclophosphamide and cyclosporine A were also investigated in PLA2R‐associated IMN. Results The positive rate of renal PLA2R antigen in recruited IMN patients was 82.3%. Non‐PLA2R‐associated IMN patients had a higher probability to achieve remission than PLA2R‐associated IMN patients (Log–rank test, P = .013). Multivariate COX analysis showed that renal PLA2R antigen was an independent risk factor for not achieving remission in IMN patients (Hazard Ratio: 1.619; 95% confidence interval: 1.133 to 2.313; P = .008). In PLA2R‐associated IMN, patients receiving cyclophosphamide had a higher probability to achieve remission compared with those receiving cyclosporine A (Log–rank test, P = .018) while there was no difference in renal survival. Multivariate COX regression analysis showed that compared with cyclosporine A, patients receiving cyclophosphamide had a higher probability to achieve remission. Conclusion Phospholipase A2 receptor ‐associated IMN patients had a lower probability to achieve remission compared with non‐PLA2R‐associated IMN. Compared with cyclosporine A, cyclophosphamide exerted better therapeutic effects in remission of proteinuria and may be the preferred immunosuppressant for PLA2R‐associated IMN.

show abstract

Section: Discussionsupporting

confidence: 72%

“…Both CTX and CsA were the first line initial immunosuppressive therapy protocol for IMN, with similar remission rate according to previous findings. 14…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical value of renal phospholipase A2 receptor deposit in the prognosis evaluation and treatment options of idiopathic membranous nephropathy: A retrospective cohort study

Xie

Dong

et al. 2020

Nephrology

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“…Therapy with calcineurin inhibitors induced remissions with similar frequency as cyclophosphamide but was associated with a higher relapse rate. 107,108 Continued daily use of a calcineurin inhibitors may maintain remission; however, the consequences of longterm therapy are unknown. In 1 controlled trial, chlorambucil, but not cyclosporine, reduced eGFR loss in membranous nephropathy with renal insufficiency.…”

Section: Treatment With Immunosuppressive Agentsmentioning

confidence: 99%

Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Floege

Barbour²,

Cattran

et al. 2019

Kidney International

201

111

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The Kidney Disease: Improving Global Outcomes (KDIGO) initiative organized a Controversies Conference on glomerular diseases in November 2017. The conference focused on the 2012 KDIGO guideline with the aim of identifying new insights into nomenclature, pathogenesis, diagnostic work-up, and, in particular, therapy of glomerular diseases since the guideline's publication. It was the consensus of the group that most guideline recommendations, in particular those dealing with therapy, will need to be revisited by the guideline-updating Work Group. This report covers general management of glomerular disease, IgA nephropathy, and membranous nephropathy.

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Phospholipase‐A2 receptor antibody, 24 hours proteinuria, and serum albumin as indicators of cyclophosphamide efficacy in idiopathic membranous nephropathy

Xiao

Liu

Zhang

et al. 2020

Clinical Laboratory Analysis

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Background We aimed to evaluate cyclophosphamide efficacy in the treatment of idiopathic membranous nephropathy (IMN) and explore the efficacy of phospholipase‐A2 receptor antibody (PLA2R‐Ab), 24 hours proteinuria, and serum albumin in predicting 6‐ and 12‐month treatment effects. Methods A retrospective analysis was performed on 135 patients with IMN who followed up after treatment. The observation points were before, and after 3, 6, and 12 months of treatment. We collected clinical indicator data at each observation point and measured PLA2R‐Ab levels before and after 3‐month treatment. Results The remission rates at 3, 6, and 12 months of cyclophosphamide therapy for patients with IMN were 41.4, 74.8, and 76.1%, respectively. Patients in whom PLA2R‐Ab turned negative within 3 months had high remission rates at 3, 6, and 12 months after treatment (P < .05). PLA2R‐Ab change at 3 months had a strong correlation with 24 hours proteinuria change at 6 months. The change in albumin concentration before and after 3‐month treatment was an independent variable related to remission rate at 6 months, and 24 hours proteinuria change before and after 6‐month treatment was an independent variable related to remission rate at 12 months after treatment. Conclusion Cyclophosphamide showed good efficacy at 3, 6, and 12 months for patients with IMN. Serum albumin change and PLA2R‐Ab change at 3 months can be used as indicators to predict remission at 6 months, respectively. Moreover, 24 hours proteinuria change at 6 months can predict remission at 12 months.

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Calcineurin inhibitors versus cyclophosphamide for idiopathic membranous nephropathy: A systematic review and meta-analysis of 21 clinical trials

Cited by 44 publications

References 27 publications

Clinical value of renal phospholipase A2 receptor deposit in the prognosis evaluation and treatment options of idiopathic membranous nephropathy: A retrospective cohort study

Clinical value of renal phospholipase A2 receptor deposit in the prognosis evaluation and treatment options of idiopathic membranous nephropathy: A retrospective cohort study

Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Phospholipase‐A2 receptor antibody, 24 hours proteinuria, and serum albumin as indicators of cyclophosphamide efficacy in idiopathic membranous nephropathy

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