Corticosteroids and Ciclosporin A in Idiopathic Membranous Nephropathy: Higher Remission Rates of Nephrotic Syndrome and Less Adverse Reactions than after Traditional Treatment with Cytotoxic Drugs

Abstract

Background/Aim: Idiopathic membranous nephropathy, the most common cause of nephrotic syndrome in adults, has been traditionally treated with corticosteroids and cytotoxic drugs. Ciclosporin A (CsA) is used in resistant cases, but also as a first-line treatment, due to the serious side effects of cytotoxic drugs. In this study, the remission rates of nephrotic syndrome and the incidence of side effects of corticosteroids and low CsA doses are compared with those after treatment with cytotoxic drugs. Methods: Seventy-seven nephrotic patients with well-preserved renal function who were treated with methylprednisolone and CsA (n = 46) or cytotoxic drugs (n = 31) were studied. The effects of treatments were estimated on the basis of remission rates of nephrotic syndrome and preservation of the renal function. Results: Remission (complete or partial) of nephrotic syndrome was observed in 85% of the patients treated with CsA and in 55% of the patients treated with cytotoxic drugs (p < 0.01). Deterioration of the renal function, more common in patients with multiple relapses and interstitial fibrosis, was observed in 26 and 23% of the patients, respectively (p = NS). Serious side effects and discontinuation of treatment were more frequent in patients treated with cytotoxic drugs (10 vs. 4%). Conclusion: The combination of corticosteroids with CsA represents a better regimen for patients having idiopathic membranous nephropathy, since it is associated with higher remission rates of nephrotic syndrome and less severe side effects than corticosteroids and cytotoxic drugs.

Administration of low-dose cyclosporine alone for the treatment of elderly patients with membranous nephropathy

“…A comparison of the outcomes of combination therapy using different immunosuppressants showed no significant difference in the overall remission rates among the CTX, MMF, and CsA groups (P > 0.05), and the remission rate was the highest in patients receiving a combination of prednisone and CsA. Renal function before the treatment is an important prognostic factor (Goumenos et al, 2007;Ponticelli and Passerini, 2010).…”

“…There are different views about the use of immunosuppressive therapy, and some studies suggest that cytotoxic drugs could decrease the proteinuria and improve the clinical remission rate in patients with membranous nephropathy. Recently, some studies showed that administration of the calcineurin inhibitor cyclosporine A (CsA) at conventional doses (3-5 mg·kg -1 ·day -1 ) significantly improved the prognosis of NS patients with worsened renal functions but was associated with complications such as hepatonephric dysfunction and infections (Goumenos et al, 2007;Ponticelli and Passerini, 2010). Further, the administration of CsA alone for the treatment of membranous nephropathy explored previously was partially effective.…”

Comparison of the Efficacy of Tacrolimus Versus Cyclosporine in the Treatment of Idiopathic Membranous Nephropathy

“…Some patients in the treated group progressed to the end stage (11% versus 50%, respectively). Goumenos et al (20) reported that during a mean follow-up of 48 months, there were no differences in rates of doubling of serum creatinine between the cyclosporine-treated patients than among those taking alkylating agents. This study showed that treatment with cyclosporine 3-6mg/kg/d or tacrolimus 0.05mg/kg/d induces remission in IMN patients over 3 months and 6 months after dialysis.…”

Treatment of Idiopathic Membranous Nephropathy

“…A retrospective study by Goumenos et al attempted to address this issue by comparing the outcomes of patients who were treated with a 6-month Ponticelli protocol (steroids plus chlorambucil or cyclophosphamide; n=31) with those treated with cyclosporine for 2 years plus steroids (n=46). 59 The use of different therapeutic regimens in the two groups reflects institutional treatment preferences over a 10-year period. Baseline characteristics of the groups were similar.…”