Efficacy and safety of tacrolimus combined with corticosteroids in patients with idiopathic membranous nephropathy: a systematic review and meta-analysis of randomized controlled trials

Tian, Zhonghua; Li, Yuxia; Xie, Yehong; Yang, Yalin; Xu, Jian‐Xin

doi:10.1007/s11255-022-03169-6

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…Therefore, the corticosteroid–cyclophosphamide treated remission in many patients with IMN compared to tacrolimus–rituximab. In addition, Tian et al (2022) assessed the efficacy and safety of tacrolimus combined with corticosteroids in patients with IMN and reported that 75 patients with renal biopsy MN and nephrotic syndrome were treated by rituximab or non-immunosuppressant. The depletion of anti-PLA 2 R was demonstrated at 6 months in 50% of patients intervened by rituximab and only in 12% of patients intervened by non-immunosuppressant Dahan et al (2017) .…”

Section: Treatment Of Membranous Nephropathymentioning

confidence: 99%

Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy

et al. 2022

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Membranous nephropathy (MN) is the most common cause of nephrotic syndrome among adults, which is the leading glomerular disease that recurs after kidney transplantation. Treatment for MN remained controversial and challenging, partly owing to absence of sensitive and specific biomarkers and effective therapy for prediction and diagnosis of disease activity. MN starts with the formation and deposition of circulating immune complexes on the outer area in the glomerular basement membrane, leading to complement activation. The identification of autoantibodies against the phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing protein 7A (THSD7A) antigens illuminated a distinct pathophysiological rationale for MN treatments. Nowadays, detection of serum anti-PLA2R antibodies and deposited glomerular PLA2R antigen can be routinely applied to MN. Anti-PLA2R antibodies exhibited much high specificity and sensitivity. Measurement of PLA2R in immune complex deposition allows for the diagnosis of PLA2R-associated MN in patients with renal biopsies. In the review, we critically summarized newer diagnosis biomarkers including PLA2R and THSD7A tests and novel promising therapies by using traditional Chinese medicines such as Astragalus membranaceus, Tripterygium wilfordii, and Astragaloside IV for the treatment of MN patients. We also described unresolved questions and future challenges to reveal the diagnosis and treatments of MN. These unprecedented breakthroughs were quickly translated to clinical diagnosis and management. Considerable advances of detection methods played a critical role in diagnosis and monitoring of treatment.

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Section: Treatment Of Membranous Nephropathymentioning

confidence: 99%

Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy

et al. 2022

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A novel approach to induce early remission in high-risk primary membranous nephropathy

Kochoyan,

Dobronravov

2024

Nephrology Dialysis Transplantation

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Background and hypothesis This prospective single-arm trial with historic controls evaluated the efficacy and safety of treatment based on a combination of rituximab, intravenous cyclophosphamide, and corticosteroids (RCP) administered at lower cumulative doses for the induction of early remission in primary membranous nephropathy (PMN). Methods We prospectively enrolled 30 high-risk PMN patients with persistent nephrotic syndrome (NS) and elevated antibodies to the phospholipase A2 receptor who underwent RCP therapy. We compared the effectiveness of RCP with that of historic controls who received rituximab-based therapy (RTX, n = 15) or cyclosporine + corticosteroids (CSA, n = 42). The primary outcomes were complete remission (CR) and overall remission (OR) by month 12 and the time to remission. Results In the RCP group, the OR and CR rates by 12 months (97% and 60%) were higher than those in the RTX group (60% and 7%, P ≤ 0.009) and the CSA group (50% and 24%, P ≤ 0.003). The median time to OR (2.8 (1.6–3.9) months) was shorter compared to RTX (7.1 (3.4–17.5) months, P = 0.008) and CSA (7.3 (6.0–13.6) months, P < 0.001). In adjusted Cox regression, hazard ratios for OR and CR attainment for RCP versus other treatments were 5.2 (95% CI: 2.8–9.6) and 4.8 (95% CI: 2.2–10.3), respectively. Propensity score-matched group analyses confirmed these results. One serious adverse event occurred in the RCP group in the follow-up of 56 patient-years. Conclusions RCP therapy is considered effective and safe for inducing early remission in high-risk PMN patients.

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Obinutuzumab in untreated primary membranous nephropathy: An observational case series

Hao,

Wang,

Zhou

et al. 2024

Nephrology

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BackgroundAs an initial treatment for primary membranous nephropathy (PMN), there remains a significant proportion of patients for whom rituximab is not fully effective. Here, we aimed to assess the effectiveness and safety of obinutuzumab as initial treatment in patients with PMN.MethodsIn this observational case series, patients diagnosed with PMN and treated with obinutuzumab as initial treatment were included. Treatment response was assessed by 24‐h urine total protein (24 h UTP) and serum albumin, and immunologic remission was assessed by phospholipase A2 receptor (PLA2R) antibodies.ResultsTwelve patients with PMN receiving obinutuzumab as initial treatment were included. Over 6 months, a statistically significant reduction in 24 h UTP levels (p = 0.003) and an increase in serum albumin levels were observed (p < 0.001). By the 6‐month follow‐up, two patients (16.7%) achieved complete remission, eight (66.6%) reached partial remission, and two (16.7%) showed no remission. Immunological remission was observed in 44.4% of evaluable patients (n = 9) after 3 months, increasing to 100% (6/6) at 6 months. Except for cases 1, 2, and 3, the total B cell counts in the remaining patients fell to less than 5 cells/μL before the administration of the second dose of obinutuzumab, including seven patients with counts as low as 0 cells/μL. Mild to moderate treatment‐related adverse events (TRAEs) were reported in 58.3% (7/12) of the patients. No serious TRAEs were reported.ConclusionsObinutuzumab demonstrates promising potential as an initial treatment for PMN, with good effectiveness and a manageable safety profile. Further large‐scale prospective studies are needed to confirm these findings.image

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Efficacy and safety of tacrolimus combined with corticosteroids in patients with idiopathic membranous nephropathy: a systematic review and meta-analysis of randomized controlled trials

Cited by 3 publications

References 22 publications

Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy

Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy

A novel approach to induce early remission in high-risk primary membranous nephropathy

Obinutuzumab in untreated primary membranous nephropathy: An observational case series

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