Retrospective analysis of tacrolimus combined with Tripterygium wilfordii polyglycoside for treating idiopathic membranous nephropathy

Abstract

BackgroundIdiopathic membranous nephropathy (IMN) is one of the most common adult nephrotic syndromes. Some patients with this disorder require immunosuppressive therapy. This retrospective case series was performed to assess the effects of tacrolimus (TAC) combined with Tripterygium wilfordii polyglycoside (TWG) in treating IMN.MethodsFrom January 2015 to August 2016, kidney-biopsy-proven IMN patients treated with TAC in the Chinese PLA General Hospital were screened. Data were retrieved from the patients’ medical records. The first efficacy evaluation index was remission rate (complete remission and partial remission), and the secondary efficacy evaluation indices included relapse rate, proteinuria, serum albumin and estimated glomerular filtration rate (eGFR). Adverse events were also assessed.ResultsThe included patients’ treatments were tacrolimus monotherapy (TAC group, n = 33), tacrolimus combined with methylprednisolone (MP) (TAC + MP group, n = 24) and tacrolimus combined with Tripterygium wilfordii polyglycoside (TAC + TWG group, n = 21). The remission rates of the TAC, TAC + MP, and TAC + TWG groups in the 10th month were 54.5, 62.5, and 85.7%, respectively (TAC + TWG group vs TAC group, P = 0.037, TAC + TWG group vs TAC + MP group, P = 0.125). Moreover, the complete remission rates of the TAC, TAC + MP, and TAC + TWG groups in the 10th month were 21.2, 20.8, and 57.1%, respectively (TAC + TWG group vs TAC group, P = 0.007, TAC + TWG group vs TAC + MP group, P = 0.012). Compared with the TAC group, the TAC + TWG group had a higher remission rate during these ten months (log-rank, P = 0.005). Compared with the TAC and TAC + MP groups, the TAC + TWG group had a higher complete remission rate (log-rank, P = 0.019 and log-rank, P = 0.005, respectively).ConclusionThis retrospective study showed that TAC combined with TWG may be effective for treating IMN. Further randomized controlled trials (RCTs) are needed to assess the efficacy and safety of TAC combined with TWG.

Retrospective analysis of Tripterygium wilfordii polyglycoside combined with angiotensin receptor blockers for the treatment of primary membranous nephropathy with sub-nephrotic proteinuria

“…Shang et al. conducted a retrospective study showed that TWG combined with tacrolimus resulted in a higher remission rate (85.7%) and lower relapse rate for treating PMN than tacrolimus combined with methylprednisolone group [ 9 ]. Furthermore, a randomized control trial reported that the remission rate is 86.9% in the TWG combined with prednisone group, similar to the tacrolimus combined with prednisone group, in treating PMN [ 8 ].…”

“…Numerous Chinese patients with immunoglobulin A nephropathy (IgAN) and Henoch-Schonlein purpura nephritis have benefited from TWG since Leishi first proposed the usage of TWG in 1977 [ 6 , 7 ]. More encouragingly, in recent years, studies have shown that TWG combined with corticosteroid or tacrolimus therapy was effective for patients with nephrotic PMN [ 8 , 9 ].…”

Efficacy and safety of tacrolimus monotherapy versus tacrolimus-corticosteroid combination therapy for idiopathic membranous nephropathy

“…In the included studies of Shang Shunlai and Zhang Xiaojuan, after TAC monotherapy or combination therapy, the TR at the tenth to twelfth month was higher than the TR at the sixth month. [ 15 , 17 ] However, TAC monotherapy had similar TR compared with TAC-corticosteroid combination therapy at the tenth to twelfth month. [ 15 , 17 ] More studies are needed to prove that TAC-corticosteroid combination therapy may have stronger immunosuppressive effects than TAC monotherapy for IMN.…”

Nephrotoxicity of Herbal Medicine and Its Prevention

“…For the treatment of rheumatoid arthritis, some of the western medicines compatible with T. wilfordii Hook F. are methotrexate, leflunomide, and etanercept (He et al, 2014;Zhou et al, 2018). In addition, the combination of tripterysium glycoside tablets with calcium dobesilate dispersible tablets or methylprednisolone is used clinically to treat nephrotic syndrome, and adverse reactions caused by this treatment are relatively slight (Shang et al, 2018). Traditional single drug compatibility and compound drug compatibility have the disadvantages of complex ingredients, low effective content, and uncontrollable quality.…”