Department of Nephrology, Hippokration General Hospital, Aristotle University, Thessaloniki, Greece.
Department of Nephrology, Laiko General Hospital, National and Kapodistrian University, Athens, Greece.
PLoS One. 2019 Aug 12;14(8):e0217116. doi: 10.1371/journal.pone.0217116. eCollection 2019.
Management of the Primary Membranous Nephropathy (PMN) usually involves administration of immunosuppressives. Cyclophosphamide (Cyclo) and Calcineurin Inhibitors (CNIs) are both widely used but only limited data exist to compare their efficacy in long term follow-up.
The aim of the present study was to estimate and compare long term effects of Cyclo and CNIs in patients with PMN.
PATIENTS-METHODS: Clinical data, histologic findings and long term outcome were retrospectively studied. The response to treatment and rate of relapse was compared between patients treated with CNIs or Cyclo based immunosuppressive regimens.
Twenty three centers participated in the study, with 752 PMN patients (Mean age 53.4(14-87) yrs, M/F 467/285), followed for 10.1±5.7 years. All patients were initially treated with Renin Angiotensin Aldosterone System inhibitors (RAASi) for at least 6 months. Based on their response and tolerance to initial treatment, patients were divided into 3 groups, group I with spontaneous remission, who had no further treatment, group II, continued on RAASi only, and group III on RAASi+immunosuppression. Immunosuppressive regimes were mainly based on CNIs or Cyclo. Frequent relapses and failure to treatment were more common between patients who had started on CNIs (n = 381) compared to those initially treated with Cyclo (n = 110), relapse rate: 25.2% vs. 6.4%, p<0.0001, and no response rate: 22.5% vs. 13.6%, p = 0.04, respectively.
Long term follow up showed that administration of Cyclo in PMN is followed by better preservation of renal function, increased response rate and less frequent relapses, compared to CNIs.
原发性膜性肾病（PMN）的治疗通常涉及免疫抑制剂的应用。环磷酰胺（Cyclo）和钙调磷酸酶抑制剂（CNIs）均广泛应用，但长期随访的疗效比较数据有限。
本研究旨在评估和比较 Cyclo 和 CNIs 在 PMN 患者中的长期疗效。
患者-方法：回顾性研究临床资料、组织学发现和长期预后。根据基于 CNIs 或 Cyclo 的免疫抑制方案，比较治疗反应和复发率。
23 个中心参与了这项研究，共纳入 752 例 PMN 患者（平均年龄 53.4（14-87）岁，男/女 467/285），随访 10.1±5.7 年。所有患者均接受至少 6 个月的肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗。根据初始治疗的反应和耐受性，患者分为三组，组 I 为自发缓解组，无需进一步治疗；组 II 仅继续使用 RAASi；组 III 继续使用 RAASi+免疫抑制治疗。免疫抑制方案主要基于 CNIs 或 Cyclo。与初始接受 Cyclo 治疗的患者（n=110）相比，初始接受 CNIs 治疗的患者（n=381）更常出现频繁复发和治疗失败，复发率：25.2% vs. 6.4%，p<0.0001；无反应率：22.5% vs. 13.6%，p=0.04。
长期随访显示，与 CNIs 相比，在 PMN 中使用 Cyclo 可更好地保护肾功能，提高反应率，减少复发。
