A controlled clinical study of efficacy of different treatment regimens for idiopathic membranous nephropathy

Objective To evaluate the clinical efficacy and safety of the following different treatment regimens for idiopathic membranous nephropathy(IMN):modified Ponticelli regimen (MPR, alternating therapy of hormone (Prednisone,Pre) combined with Cyclophosphamide (CTX), prednisone combined with CTX (Pre/CTX) and prednisone combined with Tacrolimus (Pre/TAC). Methods A total of 67 patients diagnosed with IMN by kidney biopsy from the 2^nd Hospital of Jilin University were analyzed on their clinical information about urine protein and albumin. Based on the treatment regimens, they were divided into MPR group, Pre/CTX group and Pre/TAC group. All the patients were treated for 6 months. We observed clinical efficacy in the three groups for 3-month and 6-month treatment, and monitored adverse reactions during the treatment course. Results No significant difference was observed at baseline before treatment. After 3-month treatments, in the MPR group, 8 (34.7%) of 23 patients reached partly remission and the effectiveness rate is 34.7%; in the Pre/CTX group, 1 (4.2%) of 24 patients died, 1 (4.2%) reached complete remission, 8 (33.3%) reached partly remission and the effectiveness rate is 37.5%; and in the Pre/TAC group, 8 (40.0%) of 20 Pre/TAC group patients reached partly remission and the effective rate is 40.0%. The above results in the three groups have no statistical difference. After 6-months treatments, in the MPR group, 1 (4.3%) of 23 patients died, 1 (4.3%) of the rest 22 patients reached complete remission, 12 (52.2%) reached partly remission and the effectiveness rate is 56.5%; in the Pre/CTX group, 2 (8.7%) of the rest 23 patients reached complete remission, 17 (73.9%) reached partly remission and the effective rate is 82.6%; and in the Pre/TAC group, 1 of 20 patients (5.0%) reached complete remission, 12 (60.0%) reached partly remission and the effective rate is 65.0%. The results in the 3 groups have no statistical difference. MPR had less adverse reactions during the treatments. Conclusions MPR, Pre/CTX and Pre/TAC regimens have comparable effectiveness for IMN; the MPR regimen is characterized by short treatment course and less prednisone accumulation dose, and so may have a high level of safety.