Substitution of Oral for Intravenous Cyclophosphamide in Membranous Nephropathy.

Abstract

Background:

Optimal immunosuppressive treatment for membranous nephropathy is still a matter of controversy. Current recommendations include oral cyclophosphamide combined with steroids (modified Ponticelli regimen) as first-line treatment in patients who are high risk. However, concerns about the cumulative toxicity of oral cyclophosphamide persist. In the last 30 years, a protocol based on low-dose intravenous cyclophosphamide plus steroids has been used to treat membranous nephropathy in Uruguay. We aimed to assess the efficacy of this regimen to induce clinical remission in patients with membranous nephropathy.

Methods:

In this retrospective, observational cohort study, we analyzed the outcome of 55 patients with membranous nephropathy treated between 1990 and 2017 with a 6-month course of alternating steroids (months 1, 3, and 5) plus intravenous cyclophosphamide (single dose of 15 mg/kg on the first day of months 2, 4, and 6).

Results:

At 24 months, 39 (71%) patients achieved clinical response with complete remission observed in 23 patients (42%) and partial remission in 16 (29%). Median time to achieve partial and complete remission was 5.9 and 11.5 months, respectively. Absence of response was observed in 16 patients (29%), five of whom started chronic RRT after a median follow-up of 3.5 years. Clinical relapse occurred in nine of 33 (27%) patients at a median of 34 months after treatment discontinuation.

Conclusions:

Replacement of oral cyclophosphamide with a single intravenous pulse on months 2, 4, and 6 of the modified Ponticelli regimen can be an effective and safe alternative for treatment of membranous nephropathy.

Podcast:

This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_09_24_KID0002802020.mp3.

• Authors: Leonella Luzardo, Gabriela Ottati, Jimena Cabrera, Hernando Trujillo, Mariela Garau, Carlota González Bedat, Ruben Coitiño, María H Aunchayna, José Santiago, Graciela Baldovinos, Ricardo Silvariño, Alejandro Ferreiro, Francisco González-Martínez, Liliana Gadola, Oscar Noboa, Hena Caorsi
• Journal: Kidney360 (Kidney360) Vol. 1 Issue 9 Pg. 943-949 (09 24 2020) ISSN: 2641-7650 [Electronic] United States
• PMID: 35369556 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 by the American Society of Nephrology.

Chemical References

• Immunosuppressive Agents
• Cyclophosphamide

Topics

• Cyclophosphamide (adverse effects)
• Glomerulonephritis, Membranous (drug therapy)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Remission Induction
• Retrospective Studies