The treatment of idiopathic
membranous glomerulopathy remains an enigma. We have reviewed many of the important clinical trials concerning
membranous glomerulopathy using a meta-analysis and a secondary pooled analysis to test the effects of
corticosteroid or alkylating,
therapy compared with no treatment on renal survival and complete remission of the
nephrotic syndrome. A search was performed using MEDLINE (1968 through 1993) for articles on idiopathic
membranous glomerulopathy and
glomerulonephritis. Bibliographies of articles were reviewed for completeness. Sixty-nine articles were reviewed. Meta-analysis was performed for four trials that evaluated
corticosteroids compared with no treatment and for three trials that evaluated alkylating
therapy compared with no treatment. Pooled analysis was performed on randomized and prospective studies (10 studies) and then with 22 case series added. All studies evaluated renal biopsy-proven disease. Meta-analysis was performed on the relative chance of being
in complete remission for each study. Renal survival could be evaluated by pooled analysis only. For pooled analyses, Cox's proportional hazard and logistic regression models were used to test the effect of
therapy on renal survival and the
nephrotic syndrome, respectively. Data concerning gender,
nephrotic syndrome, and geographic region were used in all statistical models. Evaluation of renal survival revealed no differences by treatment group (P > 0.1). By meta-analysis, the relative chance of complete remission was not improved for
corticosteroid-treated patients (1.55; 95% confidence interval, 0.99 to 2.44; P > 0.1), but was improved for patients treated with
alkylating agents (4.8; 95% confidence interval, 1.44 to 15.96; P < 0.05) when compared with no treatment. Pooled analysis of randomized and prospective studies, as well pooled analysis with all studies, supported the findings of the meta-analysis.
Corticosteroids or alkylating
therapy did not improve renal survival in idiopathic
membranous glomerulopathy. Complete remission of the
nephrotic syndrome was observed more frequently with the use of
alkylating agents.