Predictors of response and relapse in patients with idiopathic membranous nephropathy treated with tacrolimus

Caro, Jara; Gutiérrez‐Solís, Elena; Rojas-Rivera, Jorge; Agraz, Irene; Ramos, Natália; Rabasco, Cristina; Espinosa, Mario; Valera, Alfonso; Martin, M; Frutos, M.Á.; Perea, Lara; Juárez, G. Fernández; Ocaña, Javier; Arroyo, David; Goicoechea, Marián; Fernández, Lidia; Oliet, Aniana; Hernández, Yolanda; Romera, A.; Segarra, Alfons; Praga, Manuel

doi:10.1093/ndt/gfu306

Cited by 48 publications

(25 citation statements)

References 24 publications

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“…Patients with partial remission were followed by a higher likelihood of relapse than those with complete remission. A previous study suggested that the relapses may be partly prevented by a longer tapering period [16]. In the current study, we also found the longer tapering duration, the less chance of relapse.…”

Section: Discussionsupporting

confidence: 81%

“…The associations between these three factors and remission were also observed in a recent study [16]. However, the amount of proteinuria at baseline was not significantly associated with the probability of remission.…”

Section: Discussionsupporting

confidence: 73%

“…Recently, a study in India had observed remission rate of 71% at 12 month with tacrolimus treatment [15]. The lower remission rate observed in the current study than in previous studies can be explained by the finding that the tacrolimus blood levels in this study were relatively lower than those in previous studies [8, 16]. It’s notable that the tacrolimus treatment was continued in 111 patients at the end of follow up, the remission rate may go higher if we keep following up of these patients.…”

Section: Discussioncontrasting

confidence: 63%

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Evaluating tacrolimus treatment in idiopathic membranous nephropathy in a cohort of 408 patients

et al. 2017

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BackgroundThe KDIGO Clinical Practice Guidelines for Glomerulonephritis recommended tacrolimus as an alternative regimen for the initial therapy for Idiopathic membranous nephropathy (IMN), however, large observational studies evaluating tacrolimus treatment in IMN remains rare.MethodsA total of 408 consecutive IMN patients with nephrotic syndrome who were treated with tacrolimus in Jinling Hospital were included. The effectiveness and safety of tacrolimus treatment in IMN were analyzed in this study.ResultsThe cumulative partial or complete remission after tacrolimus therapy were 50%, 63% and 67% at 6, 12 and 24 months, respectively, and the cumulative complete remission rates were 4%, 13% and 23%, respectively. Multivariate logistic analysis showed that higher tacrolimus exposure during induction treatment, female gender, higher eGFR and no history of previous immunosuppressive therapy were independently associated with higher probability of remission. A relapse occurred in 101 of the 271 (37.3%) patients with partial or complete remission, and 18 of the 95 (18.9%) patients with complete remission. Tapering duration of tacrolimus and complete remission versus partial remission status were independent factors associated with risk of relapse. A decline in eGFR was the most frequent adverse event during tacrolimus treatment. During tacrolimus treatment, a ≥40% decrease in eGFR was observed in 43 (10.5%) patients.ConclusionsLow dose tacrolimus is effective for IMN, with a total remission rate of 66% whereas with a rather high rate of relapse. However, the safety of tacrolimus treatment needs to be further validated in large randomized clinical trials.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 73%

Section: Discussioncontrasting

confidence: 63%

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Evaluating tacrolimus treatment in idiopathic membranous nephropathy in a cohort of 408 patients

et al. 2017

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“…In a relatively large observational cohort study from Spain, 122 nephrotic MN patients with stable renal function were treated with tacrolimus [63]. Duration of treatment was 17 ± 7 months, including a full-dose (mean blood through level 6.8 ± 1.8 ng/mL) and a tapering period.…”

Section: Treatmentmentioning

confidence: 99%

Pharmacological treatment of primary membranous nephropathy in 2016

Logt¹,

Hofstra²,

Wetzels³

2016

Expert Review of Clinical Pharmacology

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“…Tacrolimus monotherapy was an effective and safe option for the treatment of MN with stable renal function. Remissons were frequent in patients with PR and could partially be prevented by a longer reducing period (14). Xu et al (15) reported that there were fewer side effects in the tacrolimus group compared with the cyclophosphamide group, indicating a better treatment tolerance in the tacrolimus group.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Background: Immunosuppressive drugs have received the most attention for Idiopathic Membranous Nephropathy (IMN) that include alkylating agents such as tacrolimus and cyclosporine. Objectives: This study was aimed to evaluate the efficacy of tacrolimus versus cyclosporine in the treatment of IMN in the Western region of Iran. Methods: This clinical trial and double-blind study was performed on IMN patients based on the primary biopsy with a range of 15 to 70 years. The patients with secondary membranous nephropathy such as hepatitis B, hepatitis C and systemic lupus erythematosus were censored from the study. Group C was treated with cyclosporine 3 -6 mg/kg/d and a low dose of prednisolone and Group T was treated with tacrolimus 0.05 mg/kg/d and low dose of prednisolone. Results: 68 patients were entered in our study, 34 patients were randomly selected in Group T and 34 patients in Group C. The 24-hour urine protein reduced significantly in the two groups after the 3rd and the 6th month compared with the baseline. Uric acid increased in Group T after 3 and 6 months compared with the baseline (P < 0.05), but there was no significant difference in Group C. Creatinine clearance increased in two groups after 3 and 6 months compared with the baseline, however, it has been just as significant in Group T after 6 months. There was no significant difference in the two groups after 3 or 6 months from the first dialysis. Conclusions: Cyclosporine and tacrolimus reduce proteinuria and serum creatinine after 6 months. Nonetheless, tacrolimus reduces urea and cyclosporine increases it. However, since the prevalence of the side effects of both drugs is similar, tacrolimus has better results in the treatment of IMN patients compared with cyclosporine.

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Predictors of response and relapse in patients with idiopathic membranous nephropathy treated with tacrolimus

Abstract: Tacrolimus monotherapy is an effective and safe option for the treatment of MN with stable renal function. Relapses are frequent in patients with PR and can be partially prevented by a longer tapering period.

Cited by 48 publications

References 24 publications

Evaluating tacrolimus treatment in idiopathic membranous nephropathy in a cohort of 408 patients

Evaluating tacrolimus treatment in idiopathic membranous nephropathy in a cohort of 408 patients

Pharmacological treatment of primary membranous nephropathy in 2016

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

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